Kwänlin
Whitehorse
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Takhini River
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Dä̀kwä̀kä̀da
Haines Junction
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Shadęl
Champagne
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Tthe yänlin
Canyon
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Lu ghä
Klukshu
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Consent for Release of Health Information
Consent for Release of Health Information
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Prenatal Consent for Release of Health Information
For the following purpose:
So there can be a linkage to between CAFN
Community wellness Staff and doctors incase of an emergency situation arises
Please indicate any others that may advocate your health status on your behalf? (spouse, family members)
Consent
I hereby consent to release my health information about my birth to: Champagne and Aishihik First Nations Community Wellness staff
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