Medical Release form

[Conrycol]

My DW and I are going on a cruise next week, without the kids, first time in years without them. Does anyone have a copy of a medical release form that we can leave with my sister-in-law. I know I've seen them on here before but I can't seem to locate it in the archive section. Thanks for the help:) .

[6rugrats]

Do a google search and you should pull one right up.

[crusinmama06]

I used one like this...AND I added to the bottom the weight for each child and the dosing info on medicines like Tylenol/Motrin/Benedryl just in case the child gets a fever or something that does not require medical attention.

 

In case of emergency, ____________________________has my

consent to authorize medical care for my child(ren) listed:

Our family physician is: ___________________________________

Address: _______________________________________

Telephone #: ____________________________________

Our hospital preference is: _________________________________

Past Medical History for each child:

Allergies: _______________________________________________

Insurance Informaton (including Group # and ID #)

______________________________________________

Contact me immediately at: ________________________________

If unable to contact me, please call: __________________________

Signed by

Name/Date:

[deemk]

I actually have one in Word format that I use that is from Quicken Family Lawyer. email me (deeanna@marykay.com) and I can send it to you. We travel quite often without our kids. :)

[LostAgain]

I got a form off the internet at one point, don't know where. It must be much more specific than the one listed above. It should contain your acknowledgement that you will be responsible for all costs that may be incurred, and the insurance information, as well as authorization for all emergency diagnosis and treatment (both medical and dental) that is necessary to preserve the health of the child, and authorizing this to be done to by any emergency treatment personnel, doctor or surgeon. It also authorizes the guardians to make any decisions until you can be reached. If nothing else, try a Girl Scout website.

[Conrycol]

thanks everyone for the help.:)

[newbiecruiser09]

I just did up a form for us to use. Plan to run this by our MD later this week to see if they need anything else (or if we need to have it notarized) Any thoughts?

 

 

MEDICAL CONSENT FORM

 

We, "Hubby", and "Wife" give consent to "grandparents' names here" to access medical care and make medical authorization decisions for our children, "child #1's name & DOB" and "child #2's name & DOB" for the time period of April XX, 2009 through May XX, 2009 while we are out of the country.

 

Signed,

 

"Hubby" Date

 

"Wife" Date

 

 

Witness:

 

Print Name

 

Signature

[6rugrats]

Be sure to leave the name and address of their pediatrician and their insurance cards, just in case.

[newbiecruiser09]

Yep, Plan to do that. Have a big document in the works with all the info about doctors, dentists, eye doctor etc and how to get to each as well as how to get to the urgent care and ER just in case.

[nothriver]

I've left nicely written consent forms with doctor, hospital, dentist, orthadontist info, prescription for his contacts, all my travel info and contact information and photocopies of insurance cards. I've also left notes hand scribbled on scrap paper I found in the glove box on the way to the airport. Fortunately, my kids have never needed medical treatment when I was away. We live in a small city and I can't imagine the hospital would turn my children away if they needed care. I think it is more likely that my teenager would break a piece of his braces or loose his last disposable contact, and my parents wouldn't know who to call for either, so in addition to thinking of the legal matters, don't forget the simple things like family physician's name and phone number and any other medical information.

 

I've never notarized a medical consent form (and someone at my workplace is a notray) but if it makes you feel more comfortable, go for it.

[6rugrats]

I've left nicely written consent forms with doctor, hospital, dentist, orthadontist info, prescription for his contacts, all my travel info and contact information and photocopies of insurance cards. I've also left notes hand scribbled on scrap paper I found in the glove box on the way to the airport. Fortunately, my kids have never needed medical treatment when I was away. We live in a small city and I can't imagine the hospital would turn my children away if they needed care. I think it is more likely that my teenager would break a piece of his braces or loose his last disposable contact, and my parents wouldn't know who to call for either, so in addition to thinking of the legal matters, don't forget the simple things like family physician's name and phone number and any other medical information.

 

I've never notarized a medical consent form (and someone at my workplace is a notray) but if it makes you feel more comfortable, go for it.

 

Yes, medical consent forms don't have to be notarized. And yes, without a consent form, your child could be denied treatment if it was not deemed an emergency.

[MamaParrotHead]

Around here, each hospital has their own that they prefer to use. I'd contact your hospital directly and ask. Who knows (GOD FORBID) what kind of time frame you're looking at in sorting out stupid paperwork or location information on a form they're not familiar with. Plus, even after you come back, that hospital will have on file that whomever you leave in charge would be OK'd to make medical decisions on the behalf of the kids.

[newbiecruiser09]

Around here, each hospital has their own that they prefer to use. I'd contact your hospital directly and ask. Who knows (GOD FORBID) what kind of time frame you're looking at in sorting out stupid paperwork or location information on a form they're not familiar with. Plus, even after you come back, that hospital will have on file that whomever you leave in charge would be OK'd to make medical decisions on the behalf of the kids.

 

Unfortunately, we live in an area that there are about 6+ different hospitals that could be used based on what happens and where it happens (my son plays baseball all over Norther VA). I talked with the ped and she said as long as they have a form they won't have a problem. I also put the dates we would be gone on the form so it should be clear who would be making decisions after that time frame (and even if not, I would trust my folks to make sound medical decisions for me kids in any case)