Free Medical Treatment Authorization for a Minor

The Medical Treatment Authorization for a Minor document is used by a parent to authorize a child care provider, parent, or other responsible person to obtain medical treatment for a child. For example, if a parent will be separated from a child for a few days or even a few hours, the parent may wish to give the care provider some medical instructions and the authority to obtain at least emergency medical treatment.

In addition to granting the authority to obtain medical treatment, this document also allows you to provide information regarding a physician, a preferred hospital, health insurance, and medications. It is also recommended that you provide contact information for the parent(s).

1. The Medical Treatment Authorization for a Minor document should be signed, but it is not necessary that the signature be witnessed or notarized.

2. Provide the original copy of the authorization to the care provider and keep one copy of the authorization for your records.

The Medical Treatment Authorization for a Minor can be terminated by notifying the care provider. Usually this occurs when the parent returns from a vacation or other absence. There is no requirement that the termination be in writing.