COPA Patient Forms
Here you’ll find the forms we use to help expedite your child’s care. If you have any questions, please feel free to call us. You’re welcome to download the forms and fill them out before you arrive for your appointment.
CONSENT BY PROXY | AUTHORIZATION FOR A CHILD’S MEDICAL TREATMENT | A parent or appointed guardian is required to accompany their child, 14 years or younger, to the child’s annual well-exam and for any vaccinations. The provider at those visits will inform the parent or guardian about the health of the child, discuss issues important to the patient, and in some cases COPA must receive permission from the parent or guardian to administer care.
SICK VISITS: A person who is authorized by the parent or guardian to provide consent for medical treatment may accompany the child for sick visit only, however, the following form must be completed and delivered to COPA for the visit or treatment to occur: Consent by Proxy Authorization Form
FORMULARIOS EN ESPANOL
CONSENTIMIENTO DE PROXY PARA EL TRATAMIENTO MÉDICO | Se requiere que un padre o tutor designado acompañe a su hijo, de 14 años o menos, al examen de bienestar anual del niño y para cualquier vacuna. El proveedor informará al padre o tutor acerca de la salud del niño, discutirá temas importantes para el paciente y, en algunos casos, COPA debe recibir permiso para administrar la atención. Una persona autorizada por el padre o tutor para proporcionar el consentimiento para el tratamiento médico puede acompañar al niño para una visita por enfermedad solamente, sin embargo, el siguiente formulario debe completarse y entregarse a COPA para que se realice el tratamiento. Autorizacion Por Consentimento Del Representante
COPA offers pediatricians in Bend and Redmond, Oregon
©2018 Central Oregon Pediatric Associates | COPA is a 5-Star medical home and the region's largest provider of pediatric health care for children, from newborn through high school.
Open 7 days a week to serve our community with four locations, extended hours and 24/7 Nurse Advice.