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1. Parties: Identifies step-parent, biological parent(s), and child details
2. Background: Explains relationship between parties and reason for consent
3. Definitions: Defines key terms used in the document
4. Scope of Consent: Details what medical decisions the step-parent can make
5. Duration: Specifies how long the consent remains valid
6. Emergency Contact Information: Lists contact details for all relevant parties
1. Limitations: Specifies any restrictions on consent authority when certain medical decisions are reserved for biological parents
2. International Travel: Consent for medical treatment abroad when family travels internationally
3. Insurance Information: Details of medical insurance coverage and procedures for when step-parent needs to deal with insurance matters
1. Schedule 1: Child's Medical History: Summary of relevant medical conditions, allergies, and medications
2. Schedule 2: Healthcare Providers: List of current doctors, specialists, and medical facilities
3. Appendix A: Copy of Birth Certificate: Proof of child's identity and parentage
4. Appendix B: Proof of Step-Parent Relationship: Marriage certificate or other evidence of step-parent status
Biological Parent
Child
Medical Treatment
Emergency Medical Care
Healthcare Provider
Medical Records
Consent
Medical Decision
Parental Responsibility
Medical Facility
Routine Care
Non-Emergency Treatment
Insurance Provider
Medical Information
Treatment Plan
Prescription Medication
Medical Emergency
Effective Date
Termination Date
Primary Care Physician
Medical Practitioner
Authorized Representative
Personal Information
Confidential Information
Scope of Authority
Duration and Termination
Emergency Procedures
Medical Records Access
Confidentiality
Information Sharing
Liability
Revocation Rights
Insurance Coverage
Communication Protocol
Geographic Jurisdiction
Travel Authorization
Dispute Resolution
Amendment Procedures
Signatures and Witnessing
Contact Details
Governing Law
Notices
Data Protection
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