Child Medical Consent & Treatment Authorization Log PDF (Free)
Record every treatment authorization for a minor with provider details and notes in one printable log.
Published December 3, 2025
When a child gets medical care, tracking what you authorized and who provided it keeps caregivers aligned and prevents confusion. This free log captures the essentials in a shareable PDF.
When to use this
- You routinely authorize care for a child and want a clear history.
- Multiple caregivers or relatives may need proof of what was authorized.
- You want a printable record to share with doctors, schools, or camps.
How to do it (fast)
- Enter the parent/guardian name, the child’s name, and primary doctor or clinic.
- Add insurance information for quick reference.
- Log each date, provider, treatment authorized, and any notes or follow-up instructions.
- Download the PDF to share with caregivers or providers.
Why this helps
- Keeps everyone aligned on what was approved and when.
- Adds context with provider names and follow-up notes.
- Runs locally in your browser—no accounts or uploads required.
Related tools
- Parental Consent for Travel Letter PDF
- Medical Records Request Letter PDF
- Medical Appointment & Symptom Log PDF
Not legal advice. Courts set their own rules. Keep your original records.