A medical authorization form agreement may also be called any of the following names:
Who should use this form?
- Medical release form
- Consent to treat form
- Child medical consent form
- Consent to treat minor children
- Caregiver consent form
Parents or guardians of minor children who want to authorize a caregiver or family member to obtain medical treatment for their child can use a medical authorization form to grant permission to that relative or caregiver. What to include in a medical authorization form agreement
The medical authorization form should include the name of each parent or guardian, the name of the child, the name of the relative or caregiver, and the relationship of the caregiver to the child. The form will also include insurance provider information, and the contact information for your child’s pediatrician, dentist, and preferred hospital.
In addition, the form will have a place to list any allergies or other special care notes about your child. Next steps
After the parent or guardian signs the medical authorization form, they should keep a copy of it on hand and give a copy to the relative or caregiver caring for the child. Make sure the relative or caregiver knows to take the medical authorization form with them if they need to seek medical care for your child. You aren't required to file the form with any official authorities.