Creating a Medical Authorization Form for Your Child and Caregivers

4021819172_a0be315438_zAs much as you hate to think about it, you know that a medical emergency or serious injury can strike one of your children at any time. You also understand that laws designed to protect parental rights and ensure children’s safety require a mother, father, or legal guardian to approve health care procedures for youngsters.

Medical Consent Letter for Grandparents

Ensuring your child gets seen at a walk-in clinic or hospital emergency department even when you cannot be there can require officially designating another adult as a temporary health care decision maker. This does not go so far as transferring power of attorney or surrendering custody. All that leaving a signed child medical care authorization form with a grandparents, babysitter, coach, or day care provider does is prevent delays in health care delivery.

Be aware that your child will never be denied lifesaving care. Federal and Indiana state laws require doctors and EMTs to treat anyone who is at risk for dying until, at a minimum, the person is stabilized. Designating someone to approve medical treatment in your absence becomes necessary when the problem involves something like setting a broken bone, stitching up a cut, or administering medications to reduce a fever or curb nausea. None of those conditions are life-threatening, but leaving any untreated prolongs a child’s suffering.

The child medical care authorization form should include:

  • Your name
  • Your child’s name
  • Your custodial relationship with the child (parent or legal guardian)
  • Caregiver’s name
  • Child’s allergies (include foods and medications)
  • Child’s up-to-date list of medications and supplements (e.g., vitamins, herbals)
  • Special considerations that may influence delivery of medical care to your child (e.g., developmental disorders, hearing/vision problems)
  • Your health insurance company’s name
  • Your insurance policy account number
  • Date(s) for which the authorization will be in effect
  • Statement affirming your intention to pay for medical services
  • Your signature
  • Caregiver’s/witness’s signature

That sounds like a lot. In reality, the form should take up less than one page unless your son or daughter has multiple special needs.

Evansville, IN, family law attorney Jay Ziemer can help you draft a standard, fill-in-the blank form that meets all the legal requirements to invest a temporary caregiver with the authority to ensure your child receives necessary medical care. Having one form that can be used multiple times is important because each caregiver you wish to designate as a health care decision maker will need individual signed authorization. More than one child’s name can appear on a single form.

Jay can also answer your questions about other types of paperwork related to caregiving and family health care. You can call him at (812) 568-4118 or set up an appointment online.

I have drafted a Medical Authorization Form. Print it and use it.