Free Printable Child Medical Consent Form (Word / PDF)

A child medical consent form is a written document used by parents or legal guardians to authorize another individual to make healthcare decisions for their children. They may grant authority to a grandparent, aunt, uncle, or family friend. Some alternative names for this form are;

• Emergency medical consent form
• Minor medical consent form
• Caregiver consent form
• Parental medical consent form
• Medical treatment authorization form
• Child medical release form

When do you need a child medical consent form?

Parents can use this form to authorize medical treatments for their minor children whenever they are away from them. You have to give parental consent if your child isn’t old enough to consent to medical treatments. Furthermore, the caregivers or healthcare professionals may face legal consequences if they act without proper consent.

Who can use a medical consent form?

A child medical consent form can be used by parents and legal guardians to grant authority to temporary caregivers. These may include;

• Grandparents or other family members
• Daycare and childcare providers
• Sports team coaches
• Teachers
• Babysitters
• Nannies

In addition, it is safe to create a child’s medical consent if parents are traveling without their child or if the child is traveling without their parents.

What to include in a child medical consent form?

Include the following basic elements in a child’s medical consent;

• Name and contact details of the parents or legal guardians
• Each minor’s name, address, and date of birth
• Name of caregiver (who is responsible for making medical decisions for the children)
• Child’s medical history (health condition, allergies, and vaccines)
• Details of healthcare provider
• Health insurance details
• Parents or legal guardians signatures

Writing a child medical consent form:

Consider the following steps to write this form;

Provide basic details of the child

This section of the form should provide the following details about the child;

• Full name
• Sex
• Date of birth
• Age
• Address

Include consent-giver information

Here, you will specify who will give consent and sign the form. Both parents should sign the form if they are available. However, the signature of one parent is also sufficient. Also, provide the name of the consenting adult and the relationship to the child.

If a legal guardian is a consent giver then attach guardianship papers or a court order to your form. Provide the complete name and contact details of the parent or legal guardian who is giving consent.

State the medical treatment

In your child’s treatment, you can select the range of medical care. Grant authorization to the caregiver to decide on specific types of medical care such as routine examinations and checkups, emergency medical treatment, medication administration, and more.

Give health background

This section enables the medical and healthcare professionals to make quick and effective decisions. Make this section as detailed as possible. Include the following details;

• Primary doctor
• Primary dentist
• Preferred medical facility
• Insurance information

Sign the document

When it comes to signing the document, affix the signatures of witnesses or have the form notarized in front of a notary public. Including witnesses or notary acknowledgment may vary by state.

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