Child Healthcare Consent Form Fill out the template

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Child Healthcare Consent Form

Last revision Last revision 08-09-2024
Formats FormatsWord and PDF
Size Size1 to 2 pages
Fill out the template

Last revisionLast revision: 08-09-2024

FormatsAvailable formats: Word and PDF

SizeSize: 1 to 2 pages

Fill out the template

The Child Healthcare Consent Form is a document that can be used by either parent(s) or guardian to grant authority to the caregiver of the children to provide and seek healthcare when required in the absence of the parents/guardian.

The parents/guardian may not always be available to give consent to provide healthcare to the children. This specifically applies when the children are taken care of by the caretaker, neighbour, warden, relative, etc.

This consent form will help the caregiver to avail necessary healthcare support to the children without any hassle in case of routine healthcare or in case of emergency. Some health providers may need the consent form to treat children in the absence of their parents/guardian. Thus, having this consent form will help to get necessary healthcare support to the children when required without any hassle or delay.


How to use this document?

This document includes all the information necessary to grant authority to a caregiver to provide medical treatment for children under their care.

The document includes the details of the consent giver (parent(s)/guardian) and the caregiver to whom the consent is given, and the details of the children to whom this form is applicable.

This document includes details regarding:

  • permissions given to the child in relation to different health-related matters, special health conditions and support required for the children;
  • the details of medications followed by the children;
  • the details about tetanus/booster shots of the children;
  • the details about preferred medical practitioners, health insurance details, emergency contact details, etc.

Once the document is filed, it can be printed on a non-judicial stamp paper of value prescribed by the concerned state and can also be notarized. A copy can be given to the caregiver and if required a copy can also be provided to the regular health care provider. A copy also needs to be kept with the consent giver (parent(s)/guardian) for any future reference.


Applicable law

The Child Healthcare Consent Form is a document used to communicate the consent of the parents/guardian consenting the caregiver of the children to take care of medical care of the children in the absence of the parents/guardian. This may be required as per the code of conduct or policy of the healthcare provider.


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