image description


We are pleased to provide you a consent form and medical data questionnaire so that treatment of your ill or injured child (under age 18 in Kentucky) is not delayed in a parents absence. Kentucky law does not consider a stepparent, grandparent, aunt/uncle, babysitter a legal substitute for the parent or guardian. This means that a person caring for a child cannot legally give permission for medical treatment without written consent from a parent/guardian. To insure a physician or a hospital will administer treatment to a child in a parents absence, it is good for parents to complete the attached form and give it to those individuals responsible for the care their minor child.

Should treatment be needed, the caregiver then presents this form to the physician or hospital. Please fill out a separate form for each child under age 18 in the family. This consent must be either notarized or witnessed. If you do not wish to leave a signed consent form, please do leave specific information with the responsible party so you can be contacted at any time.

Click here to download a Parental Consent Form.

Hardin Memorial Hospital. 913 N. Dixie Ave. Elizabethtown KY 42701.
Phone (270) 737-1212
Contact HMH