Emergency Department – 708.684.5360
Advocate Christ Medical Center feels that it is very important to begin treatment on injuries or diseases as soon as possible. In the event your child is brought to our emergency department and we are unable to contact you, this form will help us begin treatment and diagnostic testing. The emergency staff will still attempt to contact you to get personal permission to treat.
Read the entire form and complete all areas. Place your family’s last name at the top of the consent form. Relative/Friend should be someone you feel could give us more information about your child or tell us how to get in contact with you. If you require more room to write Allergies or Special Information, please use the back of this form.