AUTHORIZATION TO CONSENT TO MEDICAL TREATMENT:
The undersigned consents:
1. The administration of any treatment deemed necessary by:
OR in the event the appropriate specified practitioner is NOT available, by another licenced physician or dentist: 2. The transfer of minor to preferred hospital or any hospital reasonably accessible.
3. This authorization does not cover major surgery unless the medical opinions of two other licensed physicans or dentists concurring in the necessity for such surgery are obtained in writing prior to the performance of such surgery.