Authorization For Consent To Medical Treatment For Minors


You are about to leave for a well-deserved vacation. Your best friends/parents
have agreed to watch your children while you are gone. Everything is packed, the
kids are excited to be staying with your friends/parents and you’ve left the
emergency numbers. But there is one important detail that you may have
During your absence, your child may suffer an illness or injury that requires
medical attention. To ensure that your child will get that attention as easily as
possible, you should complete an “Authorization for Consent to Medical Treatment
for Minors” form before you leave. This form gives the child's designated care taker
or non-parent family member the right to authorize treatment if the need arises. In
an emergency situation, your child would automatically be treated. Of course,
every reasonable effort would be made to contact you as soon as possible, but it
may prove to be difficult if you are not near a telephone or do not have cell phone
As a general rule, minors cannot consent to treatment. Therefore, except in special
situations, e.g., emergency treatment or emancipation, a physician must obtain
the consent of the parent(s) or legal guardian to treat a minor. In the case of a
medical emergency, when a child requires immediate treatment in order to save
his or her life or to prevent injury to health, treatment may proceed without
parental consent.
Please complete this form. That way we will know that you have authorized the
designated person to make medical decisions in your absence.


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