Parental Consent Form

Protecting your children while you travel means more than getting a sitter. To be absolutely safe, you should provide written authorization for a responsible adult to approve any necessary emergency medical treatment for your children.

Unless a child’s injuries are life-threatening, hospital personnel and physicians cannot treat him or her without parental or guardian consent. As a result, your child may suffer unnecessary discomfort while waiting for you to be reached to approve stitching a cut or setting a broken arm.

Each time you go out of town, complete a ‘Consent for Medical Treatment of a Minor’ form. A separate, dated consent form is necessary for each of your children each time you leave town.

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LUTHERAN HEALTH NETWORK
BLUFFTON REGIONAL MEDICAL CENTER | DUKES MEMORIAL HOSPITAL | DUPONT HOSPITAL* | KOSCIUSKO COMMUNITY HOSPITAL*
LUTHERAN HEALTH PHYSICIANS | LUTHERAN HOSPITAL* | MEDSTAT | THE ORTHOPEDIC HOSPITAL* | REDIMED | REHABILITATION HOSPITAL*
ST. JOSEPH HOSPITAL*

*A physician owned hospital.

If you are experiencing a medical emergency, call 911.
*ER wait times are door to clinical professional and can change quickly depending on the urgency of patients that arrive by ambulance. Lutheran Health Network provides care to patients with life-threatening illnesses first.
Patients are seen in order of severity, therefore, your spot may not be guaranteed. In case of a life-threatening emergency, call 911.
St. Joseph Hospital is owned in part by physicians.
Patient results may vary. Consult your physician about the benefits and risks of any surgical procedure or treatment.