FORM #7 - EMERGENCY TREATMENT PROCEDURE This notice describes how medical information about you may be used, disclosed, and how you can get access to this information. I understand that THS is not a 24hr-service and has no guaranteed availability for emergencies. I understand that the services of Temah Healthcare Services, LLC are routine primary care services. I understand that in the event of an emergency or urgent medical issue, I am to dial 911. Under no circumstances should I postpone the care or evaluation of an urgent or emergency condition waiting for a visit or return communication (phone call, e-mail or fax) from providers at THS. Patient or Representative Name* First Last Relationship* Signature* Enter full nameDate* MM slash DD slash YYYY Reason Patient is unable to sign* CAPTCHAEmailThis field is for validation purposes and should be left unchanged. Δ
