parental consent form

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CLINIC Target Clinic Policy–Providing Health Care to Minors Illinois Minors – Permitted Treatments In Illinois, a minor may provide consent for medical treatment or other health services only for the following Target Clinic services: pregnancy testing. Emancipated Minors In Illinois, an emancipated minor is someone under the age of 18 who is married, a parent, pregnant, is in the armed forces, or has obtained a court order of emancipation. An emancipated minor may provide consent for any medical treatment or other health services. An emancipated minor may also provide consent for treatment for his/her child. Adults other than parents or guardians An adult other than a parent or guardian may provide consent for a minor’s medical treatment if a parent or guardian has delegated authority to that individual through a written document. If a Guest provides you with document authorizing treatment for a minor child, scan a copy into the patient’s eCW record. Maryland Minors – Permitted Treatment In Maryland, a minor may provide consent for the following Target Clinic services: pregnancy testing. Emancipated Minors In Maryland, an emancipated minor is someone under the age of 18 who is married or a parent. An emancipated minor may provide consent for any medical treatment or other health services. An emancipated minor may also provide consent for treatment for his/her child. Adults other than parents or guardians An adult may provide consent for a minor’s medical treatment if a parent or guardian has delegated authority to that individual through a written document. If a Guest provides you with a document authorizing treatment for a minor child, scan a copy into the patient’s eCW record. A relative other than a parent or guardian providing care for a minor may consent to health care for the minor if there is an “informal kinship care relationship.” The relative must have proof of this arrangement. 2
CLINIC Target Clinic Policy–Providing Health Care to Minors Minnesota Minors – Permitted Treatments In Minnesota, a minor may provide consent for the following Target Clinic services: pregnancy testing and Hepatitis B vaccinations. Emancipated Minors In Minnesota, an emancipated minor is someone under the age of 18 who is married, is a parent, is in the armed forces, or lives apart from the minor’s parents and manages his/her own financial affairs. An emancipated minor may provide consent for any medical treatment or other health services. An emancipated minor may also provide consent for treatment for his/her child. Adults other than parents or guardians An adult may provide consent for a minor’s medical treatment only if a parent or guardian has delegated authority to that individual through a written document. If a Guest provides you with document authorizing treatment for a minor child, scan a copy into the patient’s eCW record. 3
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