Authorization To Consent For Health Care Of Minor printable pdf download

AUTHORIZATION TO CONSENT FOR HEALTH

CARE OF MINOR

General Information

NOTE: THIS DOCUMENT GIVES THE PERSON YOU DESIGNATE AS YOUR CHILD’S

HEALTH CARE AGENT BROAD POWERS TO MAKE HEALTH CARE DECISIONS

FOR YOUR CHILD. USE OF THIS FORM IS OPTIONAL AND SHOULD BE

CONSIDERED ONLY IF YOU ARE COMFORTABLE WITH THE POWERS AND

PROVISIONS GRANTED BY THIS DOCUMENT.

EXPLANATION: You have the right to name someone to make health care decisions for your

child when you cannot make or communicate those decisions for whatever reason. This document

gives the person you designate as the health care agent broad powers to make health care decisions

for your child when you cannot make the decision yourself or cannot communicate your decision

concerning your child to other people.

Note: This Health Care Consent for a Minor meets the requirements of Tennessee law and is

intended to be valid in any jurisdiction in which it is presented, but places outside of Tennessee may

impose requirements that this form does not meet; therefore, if your child leaves this state we

recommend that you seek assistance from an attorney in that area who can advise you on whether

you need to sign another form of Authorization to Consent for the Health Care of Minor.

Things to Consider:

1) Talk to your family and your potential agent

You should discuss your wishes concerning the medical care for your child, mental health

treatment, and other health care decisions with your child’s health care agent. Except to the

extent that you express specific limitations or restrictions in this form, the health care agent may

make any health care decision for your child.

2) Specific duties of your child’s health care agent

This form does not impose a duty on the health care agent to exercise the granted powers, but

when a power is exercised, your child’s health care agent will be obligated to use due care to act

in your child’s best interests and in accordance with this document.

Granting this broad power also creates the potential for abuse. For this reason, we

recommend that you have a serious discussion with the potential agent before you sign it

and have it delivered to the agent. Before you sign it and have it delivered to the agent, be

confident in their ability to make the right decision for your child.

Suggested Topics to Discuss with Your Child’s Health Care Agent

• Explain what you think is important for your child’s health

Authorization To Consent For Health Care Of Minor