Consent for Medical Treatment Form

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.

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.

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________________

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.

i hope that this helps you out. just copy and paste into word to make the changes you need. i've been using this form for years. my kids are now 18,17,& 13. never had a problem yet. good luck

CHILD CARE AUTHORIZATION

I, the undersigned parent, ___________________________________, of _________________________, _________________________, California __________, hereby grant ___________________________________, of _________________________, _________________________, _________________________ __________, the authority to take temporary care of the following child(ren): _________________________. This grant of temporary authority shall begin on __________________, and shall remain effective until terminated by the undersigned.

The above named Caretaker(s) shall have the power to:

- seek appropriate medical treatment or attention on behalf of the child(ren) as may be required by the circumstances, including but not limited to, medical doctor and/or hospital visits
- authorize medical treatment or medical procedures in an emergency situation
- make appropriate decisions regarding clothing, bodily nourishment, and shelter
- explain absences from school
- pick child(ren) up from school
- sign release forms for sports
- sign release forms for field trips
- ___________________________________

Dated: __________________

________________________________________

_________________________
_________________________, California __________

April 09, 2008

___________________________________
_________________________
_________________________, _________________________ __________

To Whom It May Concern:

The purpose of this letter is to advise you of the authority given to ___________________________________.

This grant of temporary authority shall begin on __________________ and shall remain effective until terminated by the undersigned.

The above Caretaker(s) shall have the authority to:

- seek appropriate medical treatment or attention on behalf of the child(ren) as may be required by the circumstances, including but not limited to, medical doctor and/or hospital visits
- authorize medical treatment or medical procedures in an emergency situation
- make appropriate decisions regarding clothing, bodily nourishment, and shelter
- explain absences from school
- pick child(ren) up from school
- sign release forms for sports
- sign release forms for field trips
- ___________________________________

Please contact me if you have any questions or need additional information. I can be contacted by phone at ______________.

Thank you for your cooperation in this matter.

Sincerely,

Final Checklist for Child Care Authorization
Parent(s): ___________________________________
April 09, 2008

Make It Legal

_____ The Child Care Authorization document should be signed, but it is not necessary that the signature be witnessed or notarized.

Copies

_____ The Parent(s) or legal guardian should provide the original copy of the Authorization to the Caretaker(s).

_____ ___________________________________ should keep one copy of the Authorization document for his or her records.

Reasons to Update

* To change Caretaker(s).

* To change the powers granted.

* To add or remove a child(ren) from the Caretaker's powers.

K.
I am a notary public and although there are forms out there, the easiest thing to do is to type something up on your computer that gives your parents medical power of attorney over your children. Mention everyones names, including your parents, your children, your husband and yourself. You can either put a timeframe on it for just the time you are gone or you can put it for a year period of time and renew it every year. Then I would recommend having a notary public notarize it so it is legal and binding. Keep a copy for you and give the original to your parents. hope this helps and enjoy your time away.

N.

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.

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.

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.

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!

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.

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.

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

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

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.

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,

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).