Use our attorney-drafted Child Medical Consent form for parents to Authorization to Consent to Medical Treatment; Authorization for Minor's.
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A Child Medical Consent form is a written document authorizing another adult to make healthcare decisions for a minor child. For example, a grandparent, aunt, uncle, nanny, babysitter, or family friend may be taking care of your kid when an emergency occurs.
This form ensures that person can get your child proper medical care. If a parent or legal guardian is not traveling with their kid, the document is often used with a Child Travel Consent Form.
A simple Child Medical Consent form will identify the following basic elements:
As a reference, people call this form by other names:
The sample child medical consent below details an agreement between the parent, ‘Michael B Knapp’, and the child’s teacher, ‘Wade L Jobe.’ Michael B Knapp agrees to Wade L Jobe seeking medical aid for the child, Evelyn J Knapp, when she is under his care.Child Medical Consent
This consent form is commonly used when a parent or legal guardian has entrusted another person to temporarily take care of their kid.
A consent form is needed under these circumstances:
The reality of life means parents may not be with their child if an emergency occurs. This form allows parents to designate a responsible adult to authorize medical treatment for their kid.
When you are not with your kid, a Child Medical Consent form can give you the peace of mind that your son or daughter will receive prompt medical care.
Without this form, the following preventable suffering could occur:
Consequences Suffered by Parent/Adult
Consequences Suffered by Child
It should be used if the child is:
Choose an authorized caretaker who understands your moral beliefs and shares your concern for the best interest of your child.
Our sample Child Medical Consent form asks you easy questions that help you fill out the form.
1. Who is the authorized caretaker?
The parent or legal guardian designates another adult to be the authorized caretaker of their kid in cases of medical emergencies. The temporary guardian understand the parents’ wishes about medical treatment for their child.
2. What is the child’s medical history?
The parent or legal guardian should detail the minor’s health background, for example:
Listing your child’s health background helps healthcare professionals diagnose a condition and make effective medical decisions.
3. What medical treatments are allowed?
Parents can authorize the caregiver to make certain medical care decisions for some time:
Specify when (start and end date) the caretaker has the power and authority to make medical decisions of the minor.
4. What other details should be included in a Child Medical Consent?
The form may also include the following details:
Permission for Treatment: The health history provided on this form is correct to the permission and authorize the provision of emergency medical treatment for .
Grandparents and other elders are playing a larger and larger role in the care of young children in our community. In Philadelphia alone, advocates estimate that more than 60,000 children are being raised by relative caregivers, primarily grandparents and other elderly family members. This accounts for 1 in 6 children in our community.
These elders — known as kinship caregivers — have assumed the role of parent to ensure that these children receive medical care, an education, and the stability, affection, and sense of family they need to survive. Many other grandparents also care for children while parents are at work, for a few hours when needed, or during a difficult period such as a divorce.
In all such instances, older adults may need to take a child to a doctor for either routine medical care, such as check-ups, or for emergency treatment. If the caregiver is not the legal guardian or custodian, they are not able to give consent for medical, dental or mental health treatment. Pennsylvania’s Medical Consent Act provides a tool that can help resolve these problems.
The Medical Consent Act allows a parent or legal custodian to authorize another person to consent to medical, dental or mental health care for children by completing and signing a simple document. The relative or family friend that is named may consent to a child’s medical, dental, surgical, developmental, and/or mental health examination or treatment, and may have access to any and all records, including insurance records regarding such services.
The Medical Consent Act creates a procedure where children can get the necessary medical care without affecting the rights of the full-time caregiver, whether it be the child’s parent or a grandparent who has legal custody. The Act also protects physicians and insurance providers. Any person, facility or insurer who in good faith relies on a medical consent from will not be subject to civil or criminal liability for treating a minor.
A grandparent or anyone raising a child who has already obtained legal custody through the court system already has the right to consent to that child’s medical care.
Many grandparents raising grandchildren or other caregivers have only informal custody, not legal custody, or assist the parents in raising the child at certain times of the day. For example, a grandmother may serve as caregiver during the day while a child’s mother is on the welfare-to-work program. In addition, a parent with substance abuse or other problems may ask an elderly relative to care for a child temporarily, but fails to return for a lengthy period of time — or never at all. In these instances, the medical consent document allows the caregiver to consent to medical treatment and medical care for children designated in the document. Designating authorization for medical consent to a caregiver does not revoke the birth parents’ rights.
It is important to obtain a medical consent from the birth parent before a medical issue or emergency arises. It can take time to find a birth parent if the caregiver has limited contact with the parent. Having a medical consent prevents the hassles of going to court and requesting emergency legal custody. When a grandparent or other elder becomes a primary caregiver, the medical consent should be completed immediately.
The parent or legal caregiver giving the authorization may complete a medical consent form, available from many local organizations, or simply write a statement. The form or statement must contain the following:
The Medical Consent or written statement is not a permanent document. It can be revoked at anytime. The parent can revoke consent by notifying the caregiver, health care and insurance providers in writing. Parents, caregivers, heath care and insurance providers can put a time limit on the consent; however, this is not required by law.
The medical consent form may not be used if a child is in the custody of the county children and youth agency.
SeniorLAW Center assists older adults raising young children in many ways, including providing legal advice, counsel, and information, direct legal representation in custody and support matters, and referral to other available resources and services.
Seniors in Pennsylvania can discuss concerns about kinship care, raising grandchildren or other minor children by calling our Pennsylvania SeniorLAW HelpLine at 1-877 PA SR LAW (1-877 727-7529). Seniors in Philadelphia can also call SeniorLAW Center’s telephone intake line 215-988-1242. Click here to view how to access our services.
Seniors who are involved with or want to care for children at risk of abuse or neglect or in the DHS system Philadelphia can contact our FOSTERING CONNECTIONS TO KINSHIP CARE PROJECT COORDINATOR
In an emergency, you may not be able to tell your care providers about your complete medical history or you may be unavailable if your child needs attention in the emergency department of your local hospital. These forms are here to help you get the care you need in a life-threatening situation.
Emergency Information Form for Children with Special Health Care Needs
ACEP and the American Academy of Pediatrics offer parents of children with special health care needs an Emergency Information Form – a tool to transfer a child's complicated medical history and critical information in the event of an acute illness or emergency injury.
Personal Medical History
If you or a member of your family has a medical emergency, the physician will need a complete medical history. Complete this form (don’t forget to update it) and keep it in an easily accessible place. This form is convenient to use while you’re traveling.
Consent to Treat FormThis Consent to Treat Form gives a physician permission to treat your child when he or she is in someone else’s care. Complete it and make sure grandparents and babysitters have access to it.
Formas de Consentimiento (Spanish Consent to Treat Form)
This article contains information on a way certain non-parents can be allowed to consent to medical treatment of a minor child. This article was developed by the.
Most of the time, kids' accidents and emergencies are entirely unpredictable and unexpected. Of course, you don't plan on your child falling and breaking a bone while he's with a babysitter, or needing emergency care for an allergic reaction when he's staying with grandma. These incidents catch caregivers off guard, too! That's why you need to provide a medical release form to anyone caring for your child in your absence. This simple form gives clear, irrefutable consent for medical treatment.
If you cannot be reached by phone, text, or email, the form can be used in the event that your child suffers an injury that requires medical treatment. It is one of the most important steps any parent can take to ensure your children are safe, even when you're not around.
Hospitals have to treat everyone who comes through the door, right? That isn't necessarily true, especially when it comes to children. Many urgent care facilities and emergency rooms will not treat minor children unless:
That means that injuries or illnesses that aren't life-threatening may not be treated. Say your son suffers a broken bone on the playground while you're at work or out of town. You don't want him to have to wait for treatment—including pain relievers—until you can be reached.
The St. Louis Children's Hospital has a free "Permission to Treat" form that you can download and print. It is a simple, one-page document that includes all of the relevant information caregivers and medical staff need to treat your children when you're not present.
If you share legal custody with your child's other parent, make arrangements to have the form notarized together so you can both sign it. This is the best way to indicate that you both give consent for your child to receive treatment in the event that neither of you can be reached in an emergency.
This is an important document; double-check that everything's correct. There are a few additional steps you should take to ensure your child has access to health care if you are not available.
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A Caregiver Consent Form, prepared in advance, assures that the caregiver will be able to make medical decisions guided by health care professionals in your.