Designation of Another Person to Consent for Medical Care :: Nationwide Children's Hospital

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Designation of Another Person to Consent for Medical Care

Designation of Another Person to Consent for Medical Care

It is best that children are brought for medical treatment by a parent or legal guardian. However, there may be times when someone other than you takes care of your child. That person may be a baby-sitter, teacher or family member. If your child must be seen at a Nationwide Children's Hospital facility during these times, we need the person who brings your child to be able to sign a consent form for Nationwide Children’s to provide medical care.

This form allows the person you choose to seek medical treatment and sign consent for your child when you are unable to come with the child. The person you name must be 18 years of age or older.

How to Use this Consent Form

  1. Ask for this form or click on the link below and print several copies of this form.

Designation of Another Person to Consent for Medical Care (PDF)

HH-36 11/11, Revised 6/13, Copyright 2011, Nationwide Children's Hospital

Nationwide Children's Hospital
700 Children's Drive Columbus, Ohio 43205 614.722.2000