Parental Consent Form

Protecting your children while you travel means more than getting a sitter. To be absolutely safe, you should provide written authorization for a responsible adult to approve any necessary emergency medical treatment for your children.

Unless a child’s injuries are life-threatening, hospital personnel and physicians cannot treat him or her without parental or guardian consent. As a result, your child may suffer unnecessary discomfort while waiting for you to be reached to approve stitching a cut or setting a broken arm.

Each time you go out of town, complete a ‘Consent for Medical Treatment of a Minor’ form. A separate, dated consent form is necessary for each of your children each time you leave town.

t=14
LUTHERAN HEALTH NETWORK
BLUFFTON REGIONAL MEDICAL CENTER | DUKES MEMORIAL HOSPITAL | DUPONT HOSPITAL* | KOSCIUSKO COMMUNITY HOSPITAL*
LUTHERAN HEALTH PHYSICIANS | LUTHERAN HOSPITAL* | MEDSTAT | THE ORTHOPEDIC HOSPITAL* | REDIMED | REHABILITATION HOSPITAL*
ST. JOSEPH HOSPITAL*

*A physician owned hospital.

If you are experiencing a medical emergency, call 911.
*ER wait times are door to clinical professional and can change quickly depending on the urgency of patients that arrive by ambulance. Lutheran Health Network provides care to patients with life-threatening illnesses first.
St. Joseph Hospital is owned in part by physicians.
Patient results may vary. Consult your physician about the benefits and risks of any surgical procedure or treatment.