AUTHORIZATION TO CONSENT TO MEDICAL TREATMENT OF CHILD
Information of Child
____________________, male, born February 11, 2016 at ____________________ and residing at ____________________, ____________________, Virginia, __________, ____________________.
I do not authorize ____________________ to consent to the transfusion of blood.
Name: ____________________Street Address: ____________________City, State: ____________________, VirginiaZipcode: __________Country: ____________________Home Phone: __________Work Phone: __________Cell Phone: __________Email: ____________________
IN WITNESS WHEREOF, I hereunto sign my name at ____________________, Virginia this 11th day of February, 2016.
A Child Medical Consent is also known as:
A Child Medical Consent is a document which allows parents or guardians to authorize another party to consent to their child's medical treatment.
A Child Medical Consent should be used by parents or guardians who may be unable to personally consent to their child's medical treatment due to travel or other situations where the children will be in the care of others.
A Child Medical Consent authorizes another party to consent to the child's medical treatment.
A Child Travel Consent grants the child the right to travel if one or both of the child's parents/guardians are absent for the child's trip. However, the Child Travel Consent cannot grant consent for the child's medical treatments.
Child Medical Consent
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