Authorization To Consent For Health Care Of Minor

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AUTHORIZATION TO CONSENT FOR HEALTH
CARE OF MINOR
General Information
NOTE: THIS DOCUMENT GIVES THE PERSON YOU DESIGNATE AS YOUR CHILD’S
HEALTH CARE AGENT BROAD POWERS TO MAKE HEALTH CARE DECISIONS
FOR YOUR CHILD. USE OF THIS FORM IS OPTIONAL AND SHOULD BE
CONSIDERED ONLY IF YOU ARE COMFORTABLE WITH THE POWERS AND
PROVISIONS GRANTED BY THIS DOCUMENT.
EXPLANATION: You have the right to name someone to make health care decisions for your
child when you cannot make or communicate those decisions for whatever reason. This document
gives the person you designate as the health care agent broad powers to make health care decisions
for your child when you cannot make the decision yourself or cannot communicate your decision
concerning your child to other people.
Note: This Health Care Consent for a Minor meets the requirements of Tennessee law and is
intended to be valid in any jurisdiction in which it is presented, but places outside of Tennessee may
impose requirements that this form does not meet; therefore, if your child leaves this state we
recommend that you seek assistance from an attorney in that area who can advise you on whether
you need to sign another form of Authorization to Consent for the Health Care of Minor.
Things to Consider:
1) Talk to your family and your potential agent
You should discuss your wishes concerning the medical care for your child, mental health
treatment, and other health care decisions with your child’s health care agent. Except to the
extent that you express specific limitations or restrictions in this form, the health care agent may
make any health care decision for your child.
2) Specific duties of your child’s health care agent
This form does not impose a duty on the health care agent to exercise the granted powers, but
when a power is exercised, your child’s health care agent will be obligated to use due care to act
in your child’s best interests and in accordance with this document.
Granting this broad power also creates the potential for abuse. For this reason, we
recommend that you have a serious discussion with the potential agent before you sign it
and have it delivered to the agent. Before you sign it and have it delivered to the agent, be
confident in their ability to make the right decision for your child.
Suggested Topics to Discuss with Your Child’s Health Care Agent
• Explain what you think is important for your child’s health

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