Authorization to Consent to Health Care for Minor - North Carolina

Download Authorization to Consent to Health Care for Minor - North Carolina PDF

North Carolina · Fillable PDF · Free

North Carolina law lets a parent authorize another adult, such as a grandparent, relative, or caregiver, to consent to medical, dental, and other health care for a child while the parent is unavailable. North Carolina law lets a parent authorize another adult, such as a grandparent, relative, or caregiver, to consent to medical, dental, and other health care for a child while the parent is unavailable.

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Who this form is for

North Carolina law lets a parent authorize another adult, such as a grandparent, relative, or caregiver, to consent to medical, dental, and other health care for a child while the parent is unavailable.

What you'll need

Read the packet and check the receiving agency's required form.
Gather the names, dates and supporting records requested in the document.
Review the packet's signing, identification and witness instructions.

How to complete it

Fill in the child and agent (Page 1) List each child and the adult who may consent to care, and any limits.
Sign before a notary (Page 2) Doctors and hospitals rely on a notarized authorization. Bring a current, government-issued photo ID.
Give the original to the agent and a copy to the child’s doctor and school.

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