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1. Parties: Identification of all relevant parties: biological parent(s), step-parent, and child(ren), including full legal names, addresses, and relationships
2. Background: Brief explanation of the family situation and reason for granting medical consent authority to the step-parent
3. Definitions: Clear definitions of key terms used in the document, including 'medical treatment', 'emergency care', 'routine care', etc.
4. Grant of Authority: Explicit authorization for the step-parent to make medical decisions, including scope of authority granted
5. Duration of Authority: Specification of how long the consent remains valid and any conditions that might terminate it
6. Emergency Contact Information: Contact details for all parties and order of priority for contact in medical situations
7. Medical Information: Essential medical information about the child including allergies, existing conditions, and current medications
8. Execution: Signature blocks for all parties and witness/notary requirements
1. Insurance Information: Details of medical insurance coverage and policy information - include if step-parent will be involved in insurance matters
2. Limitations of Authority: Specific procedures or decisions that require additional consent from biological parents - include if certain medical decisions are to be reserved
3. Communication Requirements: Protocols for informing biological parents of medical decisions - include if specific communication rules are needed
4. Religious or Cultural Considerations: Specific religious or cultural preferences regarding medical treatment - include if relevant to the family
5. Travel Authorization: Permission for medical treatment during travel - include if step-parent will be traveling with the child
1. Schedule A - Child's Medical History: Detailed medical history including vaccinations, past procedures, and ongoing conditions
2. Schedule B - Authorized Healthcare Providers: List of current healthcare providers and preferred hospitals/clinics
3. Schedule C - Specific Treatments Authorization: List of any pre-authorized specific treatments or procedures
4. Appendix 1 - Supporting Documentation: Copies of relevant legal documents (marriage certificate, custody orders if applicable)
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