HomeMy WebLinkAbout106.150 - FD-89, Fire Explorer Medical Treatment Authorization Section 106.150
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ADMINISTRATIVE MANUAL
FORMS
106.150 FIRE EXPLORER: MEDICAL TREATMENT
AUTHORIZATION (FD-89)
EFFECTIVE: JANUARY 2008
Current Revision Date: 3/01/22 Next Revision Date: 3/01/25
Author’s Name/Rank: Kerri L. Donis, Fire Chief Review Level: 1
Administrative Support:
Annette M. Grieser,
Executive Assistant ADA
PURPOSE
When an Explorer is injured during any sponsored activity and supervised by the Post,
including going directly to or returning from the activity, he/she will be treated
accordingly with the authorization of the parent or legal guardian.
APPLICATION
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OPERATIONAL POLICY
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OPERATIONAL GUIDELINE
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PROCESS
The FD-89 is to be completed by the applicant and their parent or legal guardian prior
to entering the Fire Explorer Program.
INFORMATION
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Section 106.150
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DEFINITIONS
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CROSS REFERENCES
No cross-references recognized.
Section 106.150
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FD-88 FD-89
FRESNO FIRE DEPARTMENT
Fire Explorer Program:
Authorization to Consent to Treatment of a Minor
(I) (We), the undersigned, parents of _______________________________________
a minor, do hereby authorize the Fire Chief of the Fresno Fire Department, one of his employees,
as agents for the undersigned, to consent to any x-ray examination, anesthetic, medical or
surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be
rendered under general or special supervision of, any physician and surgeon licensed under the
provisions of the medical practice act, whether such diagnosis or treatment rendered at the office
of said physician or at a hospital, and any special medical directives noted below under
“MEDICAL DIRECTIVES” by the undersigned. In the event of any injury whereby medical
attention at the scene of the accident is deemed necessary by said agents or paramedics or
emergency medical technicians called to the scene, (I) (we) further authorize said agents to
consent on (my) (our) behalf to treatment at said scene by said paramedics or emergency
medical technicians.
It is understood that this authorization is given in advance of any specific diagnosis, treatment
or hospital care being required, but is given to provide authority and power on the part of our
aforesaid agents to give specific consent to any and all diagnosis, treatment or hospital care
which the aforementioned physician, in the exercise of his/her best judgment may deem
advisable, as long as the medical directives are abided and followed.
THIS AUTHORIZATION IS GIVEN PURSUANT TO THE PROVISIONS OF SECTION 25.8 OF
THE CIVIL CODE OF CALIFORNIA.
This authorization shall remain effective until ___________________________________,
unless sooner revoked in writing delivered to said agent (s).
SIGNATURES:
Parent(s):
Legal Guardian:
Witness:
PERSONAL HISTORY
Minor’s Date of Birth:
Minor’s Full Name (First, Middle, Last):
Personal
Physician:
Phone No.:
Section 106.150
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Medical Directives:
Medical Problems:
(10/31/2018)