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(740) 380-8000


Consent for Care of a Minor Child

Hocking Valley Community Hospital is providing this consent form and medical data questionnaire to help avoid possible delays in obtaining treatment for an ill or injured child.

This form is a consent for care of your minor child, who may become ill or injured when you or a legal guardian is not present. In such a case, a frustrating situation could develop for both the child-patient and those responsible for that child’s care or treatment.

Think of these examples:

  • If a child is injured while in the care of a babysitter or stepparent and requires medical treatment – Neither can be accepted as a “legal” substitute for the parent or guardian.
  • A young adult under the age of 18 traveling alone becomes ill and is taken to a hospital for treatment – This minor legally cannot give consent for treatment.

Avoid delays in treatment for an ill or injured child

To help you and care providers avoid potential issues, please complete and give this consent form to the person(s) who will be responsible for your minor child.