Permission for Child
Treatment Form

Being prepared can give you piece of mind. The Permission for Child Treatment Form may put you at ease and save time if an emergency arises. Are you leaving town or does your child spend a lot of time with a babysitter, nanny or family member? You may give any of these individuals the ability to authorize medical treatment for your child. This form will be accepted at Lawrence Memorial Hospital if it is completed and notarized.

The authorized party needs to keep the form and present it at the hospital when admitting the child.

Permission for Child Treatment Form