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Form authorizing medical care for a child

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Form authorizing medical care for a child
October 01, 2018 Anniversary Wishes No comments

The grandparents' medical consent form allows a parent or legal guardian to hand over all responsibility regarding their child's health care decisions to one of .

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)

I hereby give my consent and authorization for any emergency or non-emergency I hereby authorize the health care provider to discuss in full with those persons designated any Retyped and distributed by the Child Development Council.

Paperwork to Give Someone Emergency Permission While on Vacation

form authorizing medical care for a child

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.

Why You Need to Sign a Medical Release Form for Your Minor Child

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:

  • A parent is present
  • A parent has given consent in writing
  • The child's life is in danger

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. 

Printable Permission to Treat Form

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.

  1. Start by printing one copy of the medical release form for each child.
  2. Fill out the form completely. If you share custody or parenting responsibilities, be sure to include the other person's information and let them know that you're taking this step.
  3. Have the form notarized so it is legally binding. Do not sign any copies of your kid's medical consent forms until you're in the presence of the notary public. Signing them too early will nullify the entire process and you'll have to start over.

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.

Ensure the Medical Release Form Is Accurate and Legal

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.

  • Verify all of the phone numbers on the form.
  • Include primary and secondary insurance information.
  • Consider having multiple copies notarized for each child.
  • Keep notarized copies (not photocopies of the original) in multiple places. File one at your home, at your ex's home, and place one in your child's backpack. It's also best to keep a copy anywhere your child frequents on a regular basis, such as a babysitter's house.
  • Review the forms annually. If key information has changed, print new copies and start over. It's vitally important that all of the information be accurate and up to date.

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form authorizing medical care for a child

Sending the kids to vacation with a school group, trusted friends or grandparents gives both children and parents a relaxing break from regular life. Kids get to adventure into new territory, while parents have time to breathe. If this is your plan, it's a good one, but you want to be sure that the adults in charge have all the paperwork they need to get help for your kids in case of an emergency.

Written Permission From Parents

Written permission for travel isn't necessary for emergencies only. You should take the time to prepare this every time your minor children travel without parents – one or both. In fact, they may not get very far without this paper, especially if the trip involves air travel and/or foreign countries. Airline personnel can refuse to allow minor children to board a plane without a permission letter and identification. And immigration agents can deny kids entry to foreign countries when there's no documentation to show.

This is actually for your protection and that of the children. Child abduction is real and needs to be addressed at every stage of travel. Even if your kids are not heading to the airport or across an international boundary with their friends or grandparents, it's a good idea to put a permission letter together.

If you want your family attorney to draft something for you and the other parent to sign, that's fine. Otherwise, just write up a simple letter identifying yourselves, the kids and the people they are traveling with. Include locations as well as all dates involved. Then get both parents' signatures notarized. It isn't necessary to notarize in every state, but it's required in some and a good idea in all.

Medical Consent Form

The document giving permission to travel proves to authorities that your children are not being stolen. But it doesn't help in the case of a medical emergency. A minor child can't make decisions about his own health care. That's one of the responsibilities of the parents, or the parent with legal custody in a divorce.

But you want the adult traveling with your child to be able to get him emergency care in case of an accident or medical issue. Otherwise, the staff of an emergency room or urgent care facility will have to wait until they contact you to treat your child, and this could waste precious time.

You should write up a medical consent form, granting permission to the adult traveling with your child to authorize emergency medical treatment. It's a little bit like a medical power of attorney, but instead of giving someone permission to make your personal medical decisions, it gives someone the power to act for your child.

You can find blank forms online that you just fill in, sign and notarize, or you can create your own. Identify yourself, your child and the person who will have authority to seek and obtain medical care for your child in case he needs such care. List any medical issues and allergies the child has, provide insurance information and state that you agree to assume any costs associated with such care. It's also good form to state that no court orders prevent you from making such an authorization. You and the other parent should sign the form and get your signatures notarized. If you are a single parent with legal custody, attach a copy of the divorce decree giving you that status.

About the Author

Teo Spengler was born in central Alaska and has been traveling ever since. A freelance writer with an MA in English and MFA in Creative writing, she's written travel pieces for S.F.Gate, Fairmont Hotels, IHS Hotels, Jet Blue, Choice Hotels, Women of Green, eHow, Arizona Central and USA Today, among others. She has lived one the East Coast and the West, as well as Mexico, Switzerland, Italy and France. She and currently splits her time between San Francisco and France's Basque Country.

Leaf Group is a USA TODAY content partner providing general travel information. Its content is produced independently of USA TODAY.

Photo Credits

  • Jupiterimages/Polka Dot/Getty Images

Pack the right permission forms when vacationing with children.(Photo: Jupiterimages/Polka Dot/Getty Images )

Give your child's caregiver permission to make education and health care decisions. Email · Print The form is also called a "Caregiver Authorization Affidavit".

Minor (Child) Medical Consent Form

form authorizing medical care for a child

When you are leaving a child in another person’s care, consider giving that person permission to make medical decisions for the child by preparing either a one-time temporary medical release form or a medical power of attorney. Having the document notarized will make it more valid.Hav

What happens if your child gets sick and you're not there? Can a babysitter take your child to the doctor? What about a family member, a teacher or a friend? The reality is, most medical professionals will require some type of authorization from you, the parent, before administering medical treatment to a minor child. You can set this up in advance by giving your child's caretakers written authorization to make medical decisions in your absence.

TL;DR (Too Long; Didn't Read)

Have a form template saved to your computer or phone so that you can easily fill in the specific details prior to leaving your child in another's care. Also, be sure to have your release form notarized so that it will be considered valid by medical professionals.

Why Can't Sitters Take Your Child to the Doctor?

Only parents and legal guardians have the legal right to make medical decisions on behalf of children. While a sitter can certainly take a child to the doctor, the doctor may refuse to treat the child unless you have given written permission. It doesn't matter if the accompanying adult is a sibling, grandparent, aunt, licensed caretaker or a friend – if you're not there, the doctor will likely want to see some kind of authorization before treating your child.

Urgent care is a little different, and it's highly unlikely that an emergency room will turn your child away if her life was in danger. But you can eliminate these worries by setting up medical permissions in advance. As to what kind of paperwork you need, there are two options: a temporary medical release form or a power of attorney. Choose the one that's right for your situation.

How to Write a Temporary Medical Release Form

A temporary release is a one-time document that gives a specific person the right to authorize medical care for your child for a certain time period only. Use this form if, for example, you have to leave the child with a babysitter unexpectedly or you're going to be out of town for a few days, and the child is staying with a relative.

You can prepare this form yourself along these lines:

I, (your name), am out of town on (date). During this time, I authorize (name of caregiver) to consent to any medical care and treatment for my son/daughter, (name of child), that is recommended by a licensed healthcare provider. You may contact me at this phone number (your number).

The letter should be signed by both parents as well as the person who's looking after your child. Ideally, it should be notarized, but that's probably not going to happen if you're arranging childcare at the last minute. Some medical facilities will not honor a letter that has not been notarized, however.

How to Write a Power of Attorney Form

If you're leaving your child with her grandparents for few weeks over the summer, or if your child is regularly cared for by a family member, for example, then it's a good idea to put a permanent permission-to-treat document in place. What you need here is a power of attorney – one for each child – which authorizes a designated person to arrange medical treatment for your child in your absence.

A power of attorney sounds serious, but all it does is authorize another adult to act in your place. You can make the power as broad or as specific as you like. For example, you can authorize someone to make all medical decisions on behalf of your child at any time or you can limit what they can consent to, for example, no blood transfusions or no surgery unless they speak to you by telephone first.

There's no magic to this form, and the Children's Hospital of St Louis has conveniently published a Power of Consent for Medical Care of a Minor form that you can download and fill out. You can also find state-specific medical POAs online. A POA must be notarized in order to be valid. If you're married to the child's other parent or you share legal custody of the child, then both of you should sign the POA.

Other Information to Authorize Medical Care

The following information is critical to ensuring good medical care, so be sure to include it in the POA:

  • The full name and birthdate of the child.
  • The name and contact details for the child's doctor.
  • Details of any medical conditions or allergies.
  • Details of medications your child takes (name of medication and dosage)
  • Your insurance details (insurance company, policy number)

There's no need to include this information in a temporary release form, but it's a good idea to give it to the babysitter just in case.

Reviewed by: Annie Sisk, J.D.

June 30, 2019

By: Jayne Thompson

WATCH THE VIDEO ON THEME: Dr. Maynard answers 3 questions on medical forms for homecare

do hereby consent to any medical care and This authorization is effective from This consent form should be taken with the child to the hospital or physician's.

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