Get Parental Consent Form - Lutheran Hospital Of Indiana

Filling out the parental consent form is an essential step in ensuring your child's medical care is authorized when you are not present. This guide will help you navigate the online completion of the parental consent form provided by Lutheran Hospital Of Indiana.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the parental consent form and open it in your preferred editing software.
2. In the first section, provide the names of both parents or guardians. Ensure to enter complete and accurate names for proper identification.
3. Fill out the address details, including city, county, and state of residence, to confirm your location.
4. Enter the full name of the child, their age, and date of birth. This information is crucial for identification of the child receiving care.
5. Provide the caregiver’s name and their address, making sure they are an adult over 18 years of age to authorize medical care on behalf of your child.
6. Specify the range of dates during which this authorization is valid. This ensures that the caregiver has permission for the designated period.
7. Sign and date the form in the specified section, confirming your consent. If there are two parents or guardians, both should sign.
8. Obtain a witness signature to validate the form. It can be beneficial to have two witnesses sign.
9. Input contact numbers for both parents or guardians for any necessary communication regarding the child’s care.
10. Complete the section regarding the child's physician and any allergies to medications, ensuring that critical medical information is readily accessible.
11. Fill in the medical insurance details, including the policyholder's name, identification number, and emergencies contact information.
12. Once all fields are completed, you can save changes, download the form for your records, print, or share it with the caregiver.

Complete the parental consent form online today to ensure your child's medical needs are met in your absence.