Consent for Medical Treatment Form

You don't really need a "form" -- just write/type up a consent and sign and date it (that's what my husband and I did for our babysitter and she was in the medical field for 14 years).

We have just written a simple letter which our doctor approved of which states:

To Whom It May Concern:

I hereby authorize ..... residing at ...... as my proxy and grant him/her the authority to make decisions regarding the medical care of my son ..... and daughter ...... from ..... to ......

Sincerely,

Hi, Have you called your doctor? I had to get one for my daycare provider and I got it from my son's doctor's office.

This is what i use when we are leaving out of town...
http://www.forms4parents.com/?gclid=CNzZ4pGtzJICFQ6hiQodQ...
hope that helps!

Hi K., all you need to do is write a letter of consent that says,

I K. so & so give my parents ( their name ) persmission to seek any medical care for my daughter ( name ) while she is visiting or traveling with them. In the case that either parent ( both names of parents ) and all attempts to reach my daughters parents I give permission for my parents ( name )
to consent to medical treatment to stablize her condition, until ( daughters name ) parents can be notified.

sign both parents __________ date it from the time she is with them until the time she returns.

Your medical insurance info
your doctors name, and address
your daughters SS #

An discription of any medical conditions she might suffer from now, list any medications she is on.

Your parents name address

list in case of emergency number other than you in case they can't reach you ,

I been using this for years my duahgter visits her aunt every summer, it is a legal note.

hope this helps
T Miles

I have always used a hand written letter, which included where I could be reached at all times, and instructions that my parents could seek any medical care they deemed necessary in my absence for my children. I believe you could also use a medical power of attorney for the same purpose when your children are not in your care and if you could not be reached by phone and drs. would honor that as well.

I've never had to have an actual consent form. I typed up a letter of consent for each one of my kids to get treatment when in the care of my parents. I have never had a problem. Just a letter saying you give permission for your parents to make any medical attention reguarding your children. Then sign it. It has worked for me. I have never actually seen a form for that before.
W. E.

What my parents did and the parents of the children I have nannied did was to write a formal letter. In the letter they stated that the person (in this case your parents) has your permission to make medical decisions for your children in your absence, stating the dates. You can have a notary put a seal on it to make it legal. I am not sure that that is necessary, as in California a written agreement is considered legal if both parties sign and agree to the terms. If you have a friend or family member who is a lawyer check with them to be sure. In the letter also state the children's doctor and contact info. as well as dentist, etc. Then give copies of the letter to the school, daycare, doctors, etc. as well as your parents. good luck!

http://www.stfabian.org/Forms/MedicalTreatmentRelease.pdf

This one you have to pay for$9.95
http://www.urgentbusinessforms.com/medical_release.asp

I personally just typed up a hand letter for my parents who watch my daughter every day. It works when they take her to the docotrs.
Good Luck.

I have a form if you would like me to fax it to you or you can pick it up. I live in Cypress and have a daycare so my daycare parents had to fill one out.

K.

Actually, because of the different laws that govern each state, I would recommend getting a limited power of attorney drawn up which can be notarized and used for the specific reason you have indicated on the form. These forms are available usually at a cost over the internet, but most prepaid legal services can draw up a dummy contract for little to no cost. It works just like a power of attorney would on your behalf and because it is limited, only the specified directives can be carried out. Hope this helps.

U can easily just hand write 1 and have it notarized. All it needs 2 nclude is ur name giving permision 2 ur parents 2 seek care in case of an emergency for ur girls. make sure u have names of ur girls and medical info,birth date,and any allergys. And always nclude an emergency # 2 locate u. Enjoy ur trip.

You really don't need a special form, just a written and signed consent from you stating that your parents/in-laws have permission to seek medical treatment for your kids, in your absence.

here's the form. obviously you will need to properly format but this is all the legal verbage you need

AUTHORIZATION OF CONSENT FOR THE TREATMENT OF A MINOR

Child's name_________________________________ Date of Birth ________________

Address_________________________________________________________________

Home phone number ______________________________________________________

Father's name ________________________________ Work phone (____)___________
Cell phone (____)____________

Mother's name _______________________________ Work phone (____)____________
Cell phone (____)_____________

Emergency Contact____________________________ phone (_____)_______________
(In case parents cannot be reached)

Any known allergies ______________________________________________________

Medical insurance carrier_____________________________ Group No. _____________

Doctor's Name _________________________________ Phone (____)_______________

Other pertinent information_________________________________________________

I, the undersigned parent/guardian of the minor child named above, do hereby authorize

______________________________________________________________________ as agent(s) for the undersigned, to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care, which is deemed advisable by and rendered under the general or specific supervision of any physician and/or surgeon licensed under the Medical Practice Act or any dental care, which is deemed advisable by a dentist licensed under the Dental Practice Act. It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, and is given to provide authority and power on the part of aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment, hospital care or dental care which the aforementioned physician or dentist, in the exercise of his/her best judgment, may deem advisable. This authorization is given pursuant to the provisions of Section 6910 of the Family Code of the State of California and shall remain in effect through __________________________.

Signature of Parent__________________________________ Date________________

Signature of Parent__________________________________ Date________________

All you need is a general authorization and consent for medical treatment form...I wasn't able to find a free one online but I could e-mail you a copy of the one I have. I have checked with my attorney and my doctor and both have told me this is all that would be needed in case of emergency/non emergency medical treatment, in fact my mother used this form to take my son to the doctor when I couldn't get off of work. Let me know if you need a copy and I can email you one asap.