Pre-Authorization for Minor Children

BRECKINRIDGE HEALTH, INC

1011 Old Highway 60

Hardinsburg, KY 40143

270-756-7000

HOME

Because you care....

you want to make arrangements for medical care for your children when you are unable to be with them.

This document pre-authorizes your appointed representative to act in your behalf in obtaining medical care your minor children during your absence.

Please take a moment now to fill in the required information. Leave this form with those who will be caring for your children while you are away.

Please click on the link below to print the form.