/depts/,/depts/uwmf/,/depts/uwmf/patient-resources/,/depts/uwmf/patient-resources/social-guide/,/depts/uwmf/patient-resources/social-guide/manual/,/depts/uwmf/patient-resources/social-guide/manual/legal/,/depts/uwmf/patient-resources/social-guide/manual/legal/minors/,/depts/uwmf/patient-resources/social-guide/manual/legal/minors/authorization-minor/,

/depts/uwmf/patient-resources/social-guide/manual/legal/minors/authorization-minor/

20150115

page

100

UWHC,

Patient Services,

Departments & Programs,UW Medical Foundation,Patient Resources,Social Work Services Quick Guide,Social Work Manual,Legal,Minors

Authorization for a Minor's Medical Treatment

Authorization for a Minor's Medical Treatment - Departments & Programs, UW Medical Foundation, Patient Resources, Social Work Services Quick Guide, Social Work Manual, Legal, Minors

Focus

DESIGNATION OF AGENT TO MAKE MEDICAL DECISIONS FOR MY CHILD

I, __________, mother of _________ (DOB XX/XX/200X), designate my _________ as my agent to make all medical decisions concerning the diagnosis and treatment of __________ on __________ (specify date or time period no longer than 30 days). I currently have sole decision-making authority with respect to medical decisions regarding ________. Because of ________, I will be unavailable to make medical decisions regarding _________ during this time period, and I desire that _________ make all medical decisions during the time period on my behalf.

Signature of:

Signature of Witness:

Date:

Date:

FAQ

How would you recommend we advise a mom who is temporarily wanting to give health care decision-making for her teenage daughter to her sister (the mom just had a stroke)? Can she just write something up informally and sign off - maybe with a notary - or does she need to have a lawyer/file something with the court?

We approach these situations on a case-by-case basis and would typically allow the parent with decision-making authority the ability to designate an agent to make decisions when the parent is not available to do so. In the past, we've used a form such as that follows to have the parent with decision-making authority designate an agent to make decisions. The designation should be limited in scope as much as possible, and should be limited in time to something reasonable (usually no more than 30 days).

js 1/07

Resources

Authorization For Minor's Medical Treatment