Unformatted text preview: son’s behavior and responses give me no reason, in my professional judgment, to believe that this person is not fully competent to give informed and willing consent to the child’s treatment. Signature of therapist Date q Copy accepted by parent/guardian q Copy kept by therapist This is a strictly confidential patient medical record. Redisclosure or transfer is expressly prohibited by law. FORM 14. Form for generic consent to treatment of a child. From The Paper Office . Copyright 2008 by Edward L. Zuckerman. Permission to photocopy this form is granted to purchasers of this book for personal use only (see copyright page for details)....
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- Spring '10
- therapist, Edward L. Zuckerman, strictly confidential patient, different treatment choices