I/We, the undersigned, parent(s)/legal guardian(s) of student named on this form, do hereby authorize consent to any x-ray examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care for the above named individual which is deemed advisable by and is to be rendered under the general or special supervision of any physician and/or surgeon licensed under the provisions of the Medical Practice Act whether such diagnosis or treatment is rendered at the office of said physician or at a hospital. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required and is given to provide authority and power on the part of said physician to render any and all such diagnoses, treatment, or hospital care which the aforementioned physician, in the exercise of his/her best judgment, may deem advisable for my/our son/daughter.
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