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Conference moira::parenting_v3

Title:Parenting
Notice:READ 1.27 BEFORE WRITING
Moderator:CSC32::DUBOIS
Created:Wed May 30 1990
Last Modified:Tue May 27 1997
Last Successful Update:Fri Jun 06 1997
Number of topics:1364
Total number of notes:23848

963.0. "Medical Consent Form" by MNTREY::MUELA_RH () Wed Jun 12 1991 17:53

    Does anyone have the verbage for a Medical Consent Form I can
    use for my summer care provider?  
T.RTitleUserPersonal
Name
DateLines
963.1Medical authorization formYOSMTE::TOWERS_MIWed Jun 12 1991 21:1812
    I just finished a First Aid/CPR class as part of our Emergency Response
    Team efforts and the instructor was a former Fireman and Emergency
    Responder.  He really pushed us to ensure we have proper forms for our
    kids in case of an emergency and distributed a form used and accepted
    in this state. 
    In order to get the wording correct I can send or Fax you a copy of 
    the form he gave us that is often used in this State (CA).  I would 
    think it would be universal but you could check.  If you want a copy
    let me know.  I will be in training Thursday but could Fax to you Friday.
    
    Michelle
    
963.2I have the OFC recommended form for Ma.HDLITE::FLEURYWed Jun 12 1991 21:527
    RE: .0
    
    I don't know where you are but, I have a copy of the form recommended
    by the Office for Children here in Ma.  If this would be of value, send
    me your mail address.
    
    Dan
963.3GEMVAX::SANTOSThu Jun 13 1991 11:326
    I also live in MA and would like to know the number for the Office for
    children so I could get this form.  Right now my baby sitter just has a
    letter from me.
    
    Della
    
963.4Consent formWINDY::SHARONSharon StarkstonThu Jun 13 1991 11:4220
          To Whom It May Concern:


          As the parents of [name            ] we authorize the bearer of
          this letter to approve of medical treatment for our child if it is
          required and we are unable to be reached.  Our home telephone
          number is xxx.xxx.xxxx and work numbers are xxx.xxx.xxxx (mom)
          and xxx.xxx.xxxx/xxx.xxx.xxxx (dad).  Our insurance is with xxxx
          xxxxxxx and the group number is xxxxx.  Coverage may be verified
          by calling xxx.xxx.xxxx.  The insured is [insured's name       ]
          employee number xxxxxx.


          Our child's date of birth is [date of birth  ].  He is not
          allergic to any medications as far as we know.  His pediatrician
          is Dr. Xxxxxxxxx at [group name     ], xxx.xxx.xxxx.


          Signed
963.5Are they worth anythingHOTDOG::MESSIERThu Jun 13 1991 17:049
    Do these forms really carry any weight?  Will doctors and hospitals
    really accept them?   Is the caretaker liable if the parent differs
    with the decisions that could be made?  I realize the need but if
    a lawyer gets a hold of one will he have a field day?
    
    Questions, questions, questions, sounding like the four year old
    already.
    
    Dave
963.6Pediatrics at the hospitalBCSE::WEIERPatty, DTN 381-0877Thu Jun 13 1991 17:345
    We got our forms - and were told to get our forms - from the pediatrics
    department of the local hospital.  That way too, if you give them THEIR
    form, they'd have to take it, right??
    
    Patty
963.7Update.HDLITE::FLEURYFri Jun 14 1991 09:0920
    RE: a few
    
    I checked the form and the wording listed a few notes back is almost
    identical with the form I have.  One thing I noticed this time though;
    the OFC states that the form should be reviewed by the local hospital
    to insure that it is sufficient.  We are lucky in that all of the
    children we care for see the same doctors and use the same hospital
    facilities (when needed).  Take a copy of the note (.-2 I think) and
    bring it to your local hospital.  They will indicate what type of
    emergency services are covered by that sheet.
    
    You should also sign a form giving permission to distribute medication
    to your child.  This includes over-the-counter medications as well. 
    Your provider should be recording ALL administrations of any
    medication for your child.  This is an OFC requirement too.  
    
    I'll post the forms for emergency treatment and medication here within
    the next few days.
    
    Dan
963.8Permission slip will workJAWS::TRIPPWed Jul 31 1991 10:3421
    I'm late, but that's what happens with lots of time off,
    
    RE: the question of whether Emergency personnell will honor these
    forms, and overwhelming YES! (That's the EMT in me speaking)
    
    As for my form I signed for daycare, I added to the form that he is to
    be taken to a [specified] hospital, and included his medical record
    number at the hospital, but then again he does have 5 or 6 volumes on
    record up there.  I also specified not only his general pedi's name but
    his general surgeon, asthma specialist, and specified allergies to
    medicines.
    
    My understanding, at least from our provider, is that they are allowed
    to administer ONLY prescription medicines, they must have the child's
    name on the label, and they can NOT administer over the counter things
    like tylenol etc.
    
    Just a few thoughts.
    Lyn
    
    
963.9OFC says parents can provide over the counters too.HDLITE::FLEURYThu Aug 01 1991 09:239
    RE: .8
    
    There are specific forms (medication dispensing) which must be filled
    out by the parent giving permission to administer medication.  This
    includes both perscription and over the counter.  Without the form, no
    medication of any kind should be given.  Also, ALL medication must be
    provided by the parent (this includes over the counter drugs as well.)
    
    Dan
963.10POWDML::SATOWThu Aug 01 1991 13:0910
re: .9

>    Also, ALL medication must be
>    provided by the parent (this includes over the counter drugs as well.)


and left in its original container.

Clay