as agents for myself in my absence or incapacitation to consent to any examination and anesthetic, medical or surgical diagnosis or treatment and medical care which is deemed advisable by and is to be rendered under the general or special supervision of any physician or surgeon licensed under the provisions of the Medical Practice Act on the medical staff of the Gaslamp Medical Center whether or not such diagnosis or treatment is rendered at the office of Alfredo Quinonez M.D.
It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of the aforesaid agents to give specific consent to any and all such diagnosis, treatment or hospital care which aforementioned physician in the exercise of his or her best judgment may deem advisable.
I hereby authorize Gaslamp Medical Center which has provided treatment to the above- named minor to surrender physical custody of such minor to the above - named agents upon the completion of treatment.