Child Medical Consent & Treatment Authorization Log

Keep a clear record of when you authorized care, who provided it, and any follow-up notes for caregivers or providers.

Child medical consent log

Keep a dated record of authorized treatments, who provided them, and notes to share with doctors or caregivers.

Parent or guardian

Child name

Primary doctor or clinic

Insurance information

List each date you authorized treatment and who provided it.

Entry 1

Date

Provider name

Authorized treatment

Notes

Nothing is uploaded. Save the PDF to keep a clear record for caregivers and providers.