Parenting Plan (Page 5 of 7) in pdf

child/ren take(s) his/her prescription medications as directed.

•

In emergencies, each parent can consent to emergency medical treatment for our child/ren as needed.

The intent is to take care of the medical emergency first and communicate with the other parent as soon

as possible.

•

We will communicate with each other on major health care for our child/ren.

•

Each parent shall instruct our child/ren’s health care providers to list both parents on the health records.

Each parent has the right to the child/ren's medical information and records.

•

Non-emergency health care decisions will be made by:

(for each type of care, place an “X’ under “Mother”, “Father”

or “Both Parents”)

Type of Care

By Mother

By Father

By Both Parents

Medical

________

_______

Dental

________

_______

Optical

________

_______

Orthodontic

________

_______

Psychiatric

________

_______

Psychological

________

_______

Special Education

________

_______

Addiction Treatment

________

_______

Counseling

________

_______

Any health care for the child/ren, whether or not covered by insurance, that would result in an actual out-

of-pocket expense of over $500 to the parent who did not incur or consent to the expense, must be approved in

advance, in writing, by both parents or by prior court order. (Note: The court may consider whether consent for

out-of-pocket expenses in excess of $500 was unreasonably requested or withheld and order payment of the

incurred expense in some percentage other than the Guidelines Income.)

CHILD CARE:

The work-related child care provider shall be chosen by [ ] Mother [ ] Father [ ] both parents.

If occasional (not work-related) child care is needed, we [

] shall be [

]are not required to offer the other

parent the chance to provide this care before seeking someone else to care for our child/ren. The parent who

has physical custody shall make any needed occasional child care arrangements and pay any costs.

TRANSPORTATION:

[ ]The parent who is receiving our child/ren will pick him/her/them up or arrange to have him/her/them picked up.

or [ ]

The actual COSTS of transporting our children beyond ________ miles shall be paid by each parent in the

following percentages: _______% mother _______% father.

RELOCATION BY PARENT:

Neither parent shall move our child/ren more than _________ miles without our mutual written agreement or a

court order.

PARENTING PLAN

PAGE

CAO 6-3 04/12/02

Parenting Plan Page 5

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