Appendix D: authorization for consent to medical treatment of minor.AUTHORIZATION FOR CONSENT TO MEDICAL TREATMENT OF MINOR I, -- being the parent entitled to the legal and physical custody Physical custody involves the day-to-day care of a child and establishes where a child will live. The parent with physical custody has the right to have his/her child live with him/her. of my minor child --, born --, do hereby authorize To empower another with the legal right to perform an action. The Constitution authorizes Congress to regulate interstate commerce. authorize v. to officially empower someone to act. (See: authority) --, into whose care the child has been entrusted, to consent to any X-ray examination, anesthetic anesthetic Agent that produces a local or general loss of sensation, including pain, and therefore is useful in surgery and dentistry. General anesthesia induces loss of consciousness, most often using hydrocarbons (e.g. , medical, or surgical diagnosis or treatment and hospital care to be rendered to said child under the supervision and upon the advice of a physician or other medical care provider licensed to practice medicine in any state in the United States United States, officially United States of America, republic (2005 est. pop. 295,734,000), 3,539,227 sq mi (9,166,598 sq km), North America. The United States is the world's third largest country in population and the fourth largest country in area. . I further authorize --, to consent to any X-ray, examination, dental, or surgical diagnosis or treatment and hospital care to be rendered to said minor child by a dentist licensed to practice dentistry dentistry, treatment and care of the teeth and associated oral structures. Dentistry is mainly concerned with tooth decay, disease of the supporting structures, such as the gums, and faulty positioning of the teeth. in any state in the United States. This shall be valid from -- to --. Executed this -- day of --, 20 --, at --. -- Signature of Principal CERTIFICATE OF ACKNOWLEDGMENT acknowledgment, in law, formal declaration or admission by a person who executed an instrument (e.g., a will or a deed) that the instrument is his. The acknowledgment is made before a court, a notary public, or any other authorized person. OF NOTARY PUBLIC A public official whose main powers include administering oaths and attesting to signatures, both important and effective ways to minimize Fraud in legal documents.
State of --)
) SS.
County of --)
On -- before me, --, personally
(Date) (Notary)
appeared --
Signer(s)
Personally known to me - OR - proved to me on the basis of
satisfactory evidence to be the
person(s) whose name(s) is/are
subscribed to the within
instrument and acknowledged to
me that he/she/they executed the
same in his/her/their authorized
capacity(ies), and that by
his/her/their signature(s) on
the instrument the person(s), or
the entity upon behalf of which
the person(s) acted, executed the
instrument.
WITNESS my hand and official
seal.
--
Notary's Signature
IMPORTANT NOTE: This sample legal document is provided for informational purposes only and may or may not be valid in your state. This sample legal document also may not include the particular provisions you need. We strongly recommend you consult a competent family or estate planning Estate Planning The overall planning of a person's wealth, including the preparation of a will and the planning of taxes after the individual's death. Notes: Contrary to popular belief, estate planning involves much more than preparing a will, and it is not only for the attorney who is familiar with these issues. This sample document in no way constitutes, and should not be relied upon, as legal advice. |
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