JD-1734B, 05/00 Medical Authorization 24724748.373, 938.373 and 938.296(4), Wisconsin Statutes This form shall not be modified. It may be supplemented with additional material. STATE OF WISCONSIN, CIRCUIT COURT, COUNTY IN THE INTEREST OF Name Date of Birth Medical Authorization Case No. The child/juvenile filed a consent to medical services including surgical procedures on [Date] . THE COURT FINDS: 1. The child/juvenile is within the jurisdiction of this court. 2. Reasonable cause exists for these services. 3. The child/juvenile consents to the medical services including surgical procedures when needed. THE COURT AUTHORIZES: The following medical services including surgical procedures when needed: DISTRIBUTION: 1. Court 2. Treatment Facility (certified or authenticated) American LegalNet, Inc. www.FormsWorkFlow.com