do hereby authorize any administration of emergency medication by OT Connection. All other services such as; x-ray examination, anesthetic, dental, medical or surgical diagnosis or treatment by any physician or dentist licensed by the State and hospital service that may be rendered to said minor under the general, specific, or special consent of an acting agent of OT Connection, the temporary Custodian of the minor, whether such diagnosis or treatment is rendered at the office of the physician or dentist, or at a hospital licensed by the State. I/We authorize the physician or dentist to call in any necessary consultants, in his/their own discretion. We further authorize said physician or dentist to exercise his /their discretion in authorizing the disposal of any severed tissues or member. It is understood that this consent is given in advance of any specific diagnosis or treatment being required, but is given to encourage those persons who have temporary custody of the minor and said physician or dentist to exercise his/their best judgment as to the requirements of such diagnosis or medical or dental or surgical treatment. This consent shall remain effective for the duration of the patient’s treatment at OT Connection unless sooner revoked in writing, delivered to said physician or dentist of the said Persons entrusted with the custody, care and control of said minor children.
