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Orbeon Demo: Consent for emergency medical treatment

This is a simple form to give consent for emergency medical treatment to a minor. It also makes use of section template from the global library.

Renew lease?

I hereby give consent to the following organization to obtain emergency care prescribed by a licensed physician.

Organization name

Minor full name

Allergies or other concerns

First Name

Middle initial

Last Name

Phone number (555) 555-5555

Email

Street address

Street address line 2

City

State, territory, or military post

Zip code

Date

Signature

5a13ce4a1e8f43f505cab5684332a6fb27bc2ba5

Confirm

Form Submitted

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