As a parent or legal guardian, you will likely need to have other people provide care to your minor child at some point in time. This form can be used any time you will be away from your child in order to authorize the caregiver to obtain medical treatment for your child.
For example, if your child is put under the care of family members or friends, daycare, babysitters, or any type of temporary caregiver situation, then you can use this form to let them know your child’s medical background, primary doctor, and any preferences in case of an emergency. When someone else is taking care of your child, it is especially important to plan ahead for potential medical needs and emergency situations by putting them down in writing.
What is a Child Medical Consent Form?
A Child Medical Consent form, or Child Medical Release Form, is a written document authorizing another adult to make healthcare decisions for a minor child. For example, a grandparent, aunt, uncle, nanny, babysitter, or family friend may be taking care of your kid when an emergency occurs.
Child Medical Consent forms are usually used when your child is temporarily in the care of another adult, and you want to make sure the adult can help your child in the event they need medical attention.
If a parent or legal guardian is not traveling with their kid, the document is often used with a Child Travel Consent Form.
As a reference, people call this form by other names:
- Authorization to Consent to Medical Treatment
- Authorization for Minor’s Medical Treatment
- Caregiver Medical Consent Form
- Consent for Medical Treatment of a Minor
- Consent to Treat Minor Children
- Emergency Medical Consent Form
- Medical Authorization for Minor
- Medical Treatment Authorization Form
- Parental Medical Consent Form
When Do I Need a Child Medical Consent Form?
This consent form is commonly used when a parent or legal guardian has temporarily entrusted another person to take care of their kid.
A consent form is needed under these circumstances:
- The child is a minor — under the age of 18 years old
- The child is traveling with another person or group
- The child is with a babysitter or daycare center
- A chaperone or trip leader is taking care of your kid
- The parent or guardian is temporarily away on work or business trips
The reality of life means parents may not be with their children if an emergency occurs. This form allows parents to designate a responsible adult to authorize medical treatment for their kids.
What Will Happen if I Don’t Use a Child Consent Waiver?
When you are not with your kid, a Child Medical Consent form can give you the peace of mind that your son or daughter will receive prompt medical care.
Without this form, the following preventable suffering could occur:
| Consequences Suffered by Parent/Adult | Consequences Suffered by Child |
|---|---|
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How To Write a Child Medical Consent Form
Step 1 – Include Basic Child Information
Include the child’s full name, sex, date of birth, age, and address as part of the contact information listed on the Child Medical Consent Form. The child is the one being authorized by their parent or legal guardian to receive medical treatment when under the care of another person.
Step 2 – Provide Consent Giver Information
This step is a question of who will give consent and sign the form. If both parents are available, then they should both sign the form. Otherwise, if only one of the parents is available and they are the parent or legal guardian for the child’s medical care, then only one signature of that parent is sufficient.
You must specify the following:
- Name of consenting adult
- Relationship to the child
If the consent giver is a legal guardian and has guardianship papers or a court order, attach them to your Child Medical Consent form. Hospitals may request the court order and can often only proceed with proof of proper legal authority.
Step 3 – Fill in Parent/Legal Guardian Information
The parent or legal guardian is the person who is giving consent for their child to receive medical treatment when they are not present. Include the guardian’s full name and contact information, such as their address and phone number.
Step 4 – Include Caregiver Information
The caregiver is the person who will be authorized to take care of the child in case they need medical treatment. The caregiver can be a family member or friend, a babysitter, or any person taking care of the child temporarily. Provide their name and relationship to the child.
Step 5 – Write Down Emergency Contact Information
Include the contact information for an emergency contact person who can be contacted if a parent or legal guardian cannot be reached when the child is under care.
You can also include an alternative emergency contact if the first one cannot be reached or is unable to assist.
Step 6 – Clarify the Medical Treatment
You can choose the range of medical care in your child’s treatment. You may authorize the caregiver to decide specific types of medical care, including routine examinations and checkups, emergency medical treatment, emergency medical transportation, diagnostic imaging (x-rays, CT scans, MRIs), medication administration, or anesthesia-induced surgical procedures.
The start date of the medical authorization and consent should be included in the document, along with information about how long the consent is valid. You can end it on a specific date or when the parent or legal guardian has revoked the authorization.
Step 7 – Provide Health Background
This information can help medical, and healthcare professionals make quick and effective diagnoses and decisions. It is recommended to include as much information as possible, such as the child’s last tetanus shot, whether they have any known medical conditions or allergies, and if any prescription medications are currently being taken.
Make sure you provide information for the following:
Primary Doctor
Include the full name and address of the child’s doctor. It will be listed as part of the primary healthcare givers’ contact information on the medical consent form.
Primary Dentist
Including the primary dentist is optional, although this information may be helpful to have in some situations.
Preferred Medical Facility
If you do not know or have the information readily accessible, you can leave it blank and write it in later. It is recommended to include this as part of your preferences regarding the medical treatment of your child.
Insurance Information
You can optionally include health insurance information in the consent form. If you do so, remember to provide the insurance company name, policy/group number, and policyholder’s name.
Step 8 – Sign the document
You can include witness signatures or have the form notarized in front of a notary public when you want to sign the document.
The decision to include witnesses or notary acknowledgment varies by state. Check with your local or state law to make sure the form has the level of credibility to be accepted by medical and healthcare professionals.
In certain states, remote online notarization is allowed; documents executed and notarized remotely and electronically are valid and binding. Check with a local notary to see if they are authorized in your state.
What Should Be Included in a Child Medical Consent Form?
A simple Child Medical Consent form will identify the following basic elements:
- Parents: name and contact information of parent(s) or legal guardian(s)
- Child: name, address, and date of birth for each minor
- Caregiver: name of responsible adult authorized to make decisions for some time
- Medical History: child’s health condition, allergies, prescriptions, and vaccines
- Healthcare Provider: name/number of physician/pediatrician and dentist/orthodontist
- Health Insurance: name/number of insurance, policy/group number, the policyholder
- Signature: signed by the child’s parent or legal guardian
In addition to the above, there are some questions you need to answer that will help you fill out the form:
- Who is the authorized caretaker?
The parent or legal guardian designates another adult to be the authorized caretaker of their kid in cases of medical emergencies. The temporary guardian understands the parents’ wishes about medical treatment for their child.
- What is the child’s medical history?
The parent or legal guardian should detail the minor’s health background, for example:
- Health conditions like asthma, diabetes, or pacemaker
- Allergies to antibiotics, medicine, or food
- Prescription of medications currently being taken
- Date of last tetanus injection or booster
- History of vaccines
Listing your child’s health background helps healthcare professionals diagnose a condition and make effective medical decisions.
- What medical treatments are allowed?
Parents can authorize the caregiver to make certain medical care decisions for some time:
- Administer medication and prescriptions
- Anesthesia and surgical procedure
- Blood transfusions
- Dental care and treatment
- Diagnostic imaging (X-rays, CT scans, MRIs)
- Emergency medical care and treatment (i.e., CPR, surgery, hospitalization)
- Emergency medical transportation (i.e., ambulance)
- Routine examinations and check-ups
Specify when (start and end date) the caretaker has the power and authority to make medical decisions for the minor.
- What other details should be included in a Child Medical Consent?
The form may also include the following details:
- Assurances that the parent or guardian is legally allowed to make such authorizations
- The best interests of the child and the child’s health and well-being are a priority
- Financial responsibility will remain with the parents and the minor’s health insurance
- Governing law of the state that will apply with respect to medical services
- Religious or moral beliefs that should guide the caretaker and healthcare professionals
Sample Child Medical Consent Form
Below you will find a sample child medical consent form which you can download in PDF or Word format.
Child Medical Consent
Child Medical Consent Form Frequently Asked Questions
Who can consent to medical treatment for a child?
Parents and legal guardians can give consent to medical treatment for a child. But sometimes, there are situations where a child may not have a parent or legal guardian present. In such cases, the following persons can give consent:
- Qualified adult relatives – adult relatives who live with the child, such as their sibling, aunt/uncle, or grandparent. A child medical consent form is still required.
- Foster parents – if granted guardianship by the court or given consent by the child’s legal custodians, foster parents can consent to “ordinary” medical treatment. For example, immunizations, physical exams, or x-rays. Foster parents are not allowed to consent to surgical, experimental/controversial treatments or medications for the child.
- Stepparents – A stepparent can consent to medical treatment if they have legally adopted the child or is their legal guardian. Otherwise, they must be living with the child and provide a child medical consent form.
Do both parents have to consent to medical treatment for a child?
No, both parents don’t have to consent to medical treatment for a child. For married couples, the permission of one parent is enough for the child to receive healthcare. A divorced parent with joint or sole legal custody can also make healthcare decisions on their child’s behalf.
Some joint custody agreements can have provisions stating both parents need to consent to medical treatment. If the parents can’t agree, they will have to take the matter to court and have a judge decide.
Does a child medical consent form need to be notarized?
Yes, a child medical consent form does need to be notarized. If you want the document to be legally binding, it should be signed before a notary public, ideally by both parents.
Can grandparents give medical consent?
Yes, grandparents can give medical consent. But only when a parent or legal guardian has authorized them to make healthcare decisions for your child.
The grandparent must present a signed child medical consent form before your child can receive medical care. In an emergency, the document is essential as healthcare professionals will not perform medical procedures until they contact the parent/legal guardian.
You should ensure the grandparent has a completed medical consent form stored in a place they can quickly access. Your child can then receive medical care without delay, and you can avoid unnecessary stress.