Parent Going Out Of Town Medical Release Form Template for England and Wales

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Parent Going Out Of Town Medical Release Form

"I need a Parent Going Out Of Town Medical Release Form for my 12-year-old daughter who will be staying with her aunt while I'm on a business trip to Japan from March 15-30, 2025, and I want to ensure all necessary medical decisions can be made in my absence, particularly as my daughter has a severe peanut allergy."

Document background

The Parent Going Out Of Town Medical Release Form is essential when parents or legal guardians need to temporarily delegate medical decision-making authority while they are away. Common in England and Wales, this document ensures continuous access to medical care for minors by authorizing a trusted adult to make time-sensitive medical decisions. The form typically includes the child's medical history, insurance information, current medications, known allergies, and specific care instructions. It provides healthcare providers with legal assurance that the temporary caregiver has authority to consent to medical treatment, while clearly defining the scope and duration of this authority.

Suggested Sections

1. Parent/Guardian Information: Full contact details and identification of parent(s)/guardian(s), including full name, address, contact numbers, and email

2. Child Information: Full details of child including name, date of birth, NHS number, medical conditions, allergies, and current medications

3. Temporary Caregiver Information: Details of person(s) temporarily responsible for child, including full name, address, relationship to child, and contact information

4. Duration of Authority: Specific dates for which the authorization is valid, including start and end dates of temporary care arrangement

5. Medical Authorization: Scope of medical decisions authorized, including emergency treatment, routine care, and any specific restrictions

6. Emergency Contacts: List of additional emergency contacts and their relationship to the child, including contact numbers and order of priority

Optional Sections

1. Insurance Information: Medical insurance details including policy numbers, provider contact information, and coverage details

2. Special Instructions: Specific care instructions, dietary requirements, behavioral considerations, or medical restrictions

3. Travel Authorization: Permission for domestic travel with specific limitations and requirements for notification

Suggested Schedules

1. Schedule A - Medical History: Detailed medical history including vaccinations, past conditions, surgeries, and ongoing treatments

2. Schedule B - Medication Schedule: Detailed medication instructions including dosage, timing, and administration requirements

3. Schedule C - Healthcare Providers: List of child's regular healthcare providers including GP, specialists, dentist, and their contact information

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

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Let's create your Parent Going Out Of Town Medical Release Form

Authors

Alex Denne

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