as agent(s) for the undersigned to consent to any x-ray examination, medical, or dental diagnosis or treatment which is deemed advisable by, and is to be rendered under the general or special supervision of, any clinician licensed under the provisions of the Medical Practice Act on the medical staff of Community Medical Centers.
It is understood that this authorization is given in advance of any specific diagnosis or treatment being required but is given to provide authority to the above described agent(s) to give specific consent to any and all such diagnosis or treatment which a clinician, meeting the requirements of this authorization, may, in the exercise of his/her best judgment, deem advisable.
This authorization is given pursuant to the provisions of California Family Code section 6910.
These authorizations shall remain effective for one (1) year from this date, unless sooner revoked in writing delivered to the agent(s) noted above.