Christina Rivera

 
 IVICIN 
 2735 Napoleon Avenue 
 Shawn Williams 
 New Orleans LA 70115 
 MRN: 1355335, DOB: 1987 Mar 27, Sex: F 
 Acct #: 35002782535 
 Adm: 2018 Aug 12
 2018 Feb 07 - ED in Baptist - Emergency Dept (continued) 
 Scans for Entire 
 Hospital Authorization - Electronic signature on 2021 Jan 26 7:21 AM (effective from 2018 Jul 02) - E-signed 
 Karen Marie Johnson 
 Ochsner 
 MRN: 1355335
 DOB: 1987 Mar 27
 Health 
 Age: 59 y.o. 
 Sex: female 
 HOSPITAL AUTHORIZATION 
 A. 
 Health Consent for Examination and Treatment: I hereby authorize the providers and employees of Ochsner 
 System ("Ochsner") to provide medical treatment/services which includes, but is not limited 
 not performing limited and administering tests and diagnostic procedures that are deemed necessary, including, to, but 
 the to, imaging examinations, blood tests and other laboratory procedures as may be required by 
 special instructions of my physician(s). 

 1. 
 I understand and agree that this consent covers all authorized persons, including but not limited to 
 residents, nurse practitioners, physicians' assistants, specialists, consultants and independently 
 procedures and medical or surgical treatment. 
 contracted physicians who are called upon by the physician in charge to carry out the diagnostic 
 2. I hereby authorize Ochsner to retain or dispose of any specimens or tissue, should there be such 
 remaining from any test or procedure. 

 Generated on 2018 Jul 02 4:20 PM 
 Page 135
