Oregon Community Programs

Emergency Release Form


I, , hereby give permission to Oregon Community Programs to call and obtain the service of a physician or hospital for medical care for should an emergency arise. I understand that a conscientious effort will be made to locate me before any action will be taken. I also authorize Oregon Community Programs to involve in certain potentially hazardous activities.

 

(Phone number)

 

(Date)

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Signature Certificate
Document name: Emergency Release Form
lock iconUnique Document ID: a526f842946ca9b34ad7307464588e1af8a73263
Timestamp Audit
March 26, 2020 10:39 am PDTEmergency Release Form Uploaded by OCP Documents - ocpdocs@oregoncp.org IP 10.0.10.40
March 26, 2020 10:53 am PDTIntake Coordinator - hazeld@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
March 26, 2020 1:17 pm PDTIntake Coordinator - hazeld@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
March 26, 2020 1:29 pm PDTIntake Coordinator - hazeld@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
April 6, 2020 1:56 pm PDTIntake Coordinator - hazeld@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
April 6, 2020 1:56 pm PDTIntake Coordinator - erikaf@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
April 8, 2020 10:10 am PDTIntake Coordinator - hazeld@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
April 8, 2020 10:10 am PDTIntake Coordinator - erikaf@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
April 8, 2020 10:55 am PDTIntake Coordinator - hazeld@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
April 8, 2020 10:55 am PDTIntake Coordinator - erikaf@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
April 13, 2020 11:32 am PDTIntake Coordinator - ocpclientpaperwork@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
January 15, 2021 12:48 pm PDTIntake Coordinator - ocpclientpaperwork@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
January 27, 2021 1:31 pm PDTIntake Coordinator - ocpclientpaperwork@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.10.43
January 27, 2021 1:31 pm PDTOCP Admin - mindib@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.10.43
April 27, 2021 4:19 pm PDTIntake Coordinator - ocpclientpaperwork@oregoncp.org added by Mindi Brock - mindib@oregoncp.org as a CC'd Recipient Ip: 10.0.1.85
September 14, 2022 12:55 pm PDTOCP Documents - ocpdocs@oregoncp.org added by OCP Documents - ocpdocs@oregoncp.org as a CC'd Recipient Ip: 10.0.10.40
Audit trial Qr code
This audit trail report provides a detailed record of the online activity and events recorded for this document.
https://www.oregoncommunityprograms.org/
Audit Trail Serial# fe05c4044e5274ebd96c75fd04b38691