March 02, 2006,
L.M. asks from Wheaton, IL on March 01, 2006
Going Out of Town W/o Child... Need a Letter for Care
I am going out of the country and leaving my 3 y.o. daughter in the care of my grandmother. While away she asked that I provide her with a letter to cover anything that might happen. I guess I should incorporate care and medical treatment authorization. Any suggestions on what my letter should encompass and look like? Thanks!
2 moms found this helpful
T.C. answers from Chicago on March 02, 2006
Hi Lily --
Here is the language from the authorization we use whenever we travel. We got this from our doctor, so we're pretty comfortable with the language. One other thing to remember when you travel is to always leave a copy of your insurance and prescription cards in case your caregivers are challenged.
We, the undersigned parents of ___________________, a minor, do hearby authorize _______________________ as agent(s) for the undersigned to consent to an x-ray examination, and anesthetic, medical, or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician and surgeon licensed under the provisions of the Medical Practice Act on the medical staff of any hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital.
It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but is given to provide authority to power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care which a physician, meeting the requirements of this authorization, may in the exercise of his/her best judgment deem advisable.
We hereby authorize any hospital which has provided treatment to the above named minor to surrender physical custody of such minor to my/or above named agent(s) upon the completion of treatment.
These authorizations shall remain effective until _______, unless sooner revoked in writing delivered to said agent(s).
I hope this helps.
1 mom found this helpful
V.F. answers from Chicago on March 02, 2006
I have a Go Mom Planner that I purchased at Target (for about $6.00) in the back it has what is called a Medical authorization form. What it says is:
In my absence on (date), I authorize medical treatment for (child's name) whi is in the care of:
Then there is a place for the pediatricians name, address, phone number, name of practice, alternate doctor, insurance provider, phone number, address, group ID, subscriber #, and then important info on my child:
SSN, date of birth, alergies, current medications, and then the parents signature's (both) and the date.
I gave this to my mother in law when she was watching my daughter.
Hope this is helpful.
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R.K. answers from Chicago on March 01, 2006
SPECIAL POWER OF ATTORNEY FOR MEDICAL AUTHORIZATION
I, __________, of __________, hereby appoint __________ of __________, as
my attorney in fact to act in my capacity to do any and all of the
1. Make any and all decisions and authorize all procedures that
__________may deem necessary regarding the medical treatment of my
children, __________ and/or _________.
The rights, powers, and authority of my attorney in fact to exercise any
and all of the rights and powers herein granted shall commence and be in
full force and effect and shall remain in full force and effect until
__________ or unless specifically extended or rescinded earlier by either
Dated __________, 20____.
STATE OF __________ COUNTY OF __________
BEFORE ME, the undersigned authority, on this __________ day of __________,
20____, personally appeared __________to me well known to be the person
described in and who signed the Foregoing,and acknowledged to me that he
executed the same freely and voluntarily for the uses and purposes therein
WITNESS my hand and official seal the date aforesaid.
My Commission Expires: __________
B.W. answers from Chicago on March 01, 2006
I did this last year for my parents when they took my daughter on a camping trip. I have the free legal forms link at home, and unfortunatly I am at work right now. If I locate it later I will post it, but if anything email me a reminder and I will email it to u directly. It was great, all I had to do was fill in the blanks and it made the form for me. ~B. ____@____.com
K. answers from Chicago on March 01, 2006
Don't forget to make a copy of your medical insurance card.
J.L. answers from Chicago on March 01, 2006
Hi, if you respond with your email address I can scan and email you a copy of a form I have here that an at home day care provider (friend) gave to me - she uses it at her day care.