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1. Parties: Identifies the parent(s)/legal guardian(s) granting consent and the babysitter receiving authorization
2. Background: Brief context explaining the purpose of the consent form and the caregiving arrangement
3. Definitions: Defines key terms used in the document such as 'emergency medical care', 'authorized medical provider', etc.
4. Child's Information: Full details of the child including full name, date of birth, and any identifying information
5. Medical Authorization Grant: Explicit authorization for the babysitter to seek and consent to medical treatment
6. Scope of Authority: Clearly defines what medical decisions the babysitter can and cannot make
7. Emergency Contacts: Prioritized list of emergency contacts including parents, alternate guardians, and family doctor
8. Medical Information: Child's relevant medical history, allergies, medications, and health conditions
9. Hospital Preference: Preferred hospital/medical facility for emergency treatment
10. Duration of Authorization: Specifies the time period for which the consent is valid
11. Execution: Signature blocks for all parties with date and witness provisions
1. Religious Preferences: Specific religious requirements or restrictions regarding medical treatment, relevant for families with specific religious beliefs
2. Insurance Information: Details of medical insurance coverage, optional but recommended for inclusion
3. Indemnification: Clause protecting the babysitter from liability when acting in good faith under the authorization
4. Vaccination Records: Section for detailed vaccination history, particularly relevant for younger children or those with specific medical conditions
5. Travel Authorization: Additional authorization for the babysitter to transport the child for medical care, if needed
6. Specific Treatment Restrictions: Any specific treatments or procedures that are explicitly not authorized
7. Cost Responsibility: Clarification of who bears the cost of medical treatment, recommended for longer-term arrangements
1. Schedule A - Medical History Form: Detailed medical history form including past conditions, surgeries, and ongoing health issues
2. Schedule B - Current Medications: List of current medications, dosages, and administration instructions
3. Schedule C - Emergency Protocol: Step-by-step instructions for different types of medical emergencies
4. Schedule D - Insurance Card Copies: Copies of relevant medical insurance cards and documentation
5. Schedule E - Physician's Notes: Any relevant notes or instructions from the child's regular physician
6. Schedule F - Emergency Contact Details: Detailed contact information for all listed emergency contacts, including alternate numbers and email addresses
Authorized Medical Provider
Medical Treatment
Legal Guardian
Child
Caregiver
Emergency Contact
Medical Facility
Consent
Healthcare Decision
Identity Card
Medical History
Prescribed Medication
Treatment Authorization
Emergency Services
Medical Insurance
Regular Physician
Hospital
Authorization Period
Medical Condition
Medical Information
Emergency Procedures
Consent
Liability
Duration
Confidentiality
Insurance
Religious Considerations
Transportation
Cost and Expenses
Revocation
Indemnification
Witness Requirements
Governing Law
Termination
Communication Protocol
Record Keeping
Emergency Contact
Scope of Authority
Childcare Services
Healthcare
Education
Family Services
Domestic Services
Social Services
Private Households
Child Protection Services
Emergency Medical Services
Legal
Compliance
Child Protection
Healthcare Administration
Risk Management
Family Services
Emergency Services
Document Management
Client Relations
Babysitter
Nanny
Childcare Provider
Au Pair
Child Protection Officer
Family Services Coordinator
Emergency Care Coordinator
Healthcare Administrator
Childcare Center Director
Family Lawyer
Legal Document Specialist
Risk Management Officer
Child Welfare Officer
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