Permission to authorize Wonder Kids Specialty Pediatrics to provide routine or emergency medical care as they deem necessary on my behalf for my minor child, and in doing so to obtain confidential information under HIPAA laws regarding my child’s medical records, treatment, and diagnosis.
I, (Choose below) authorize my minor child age 16 and over to come to appointments by his/herself for medical care.
This authorization shall remain in effect until it is revoked by me.
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