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Pediatric Medical Release Form Template for England and Wales

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Key Requirements PROMPT example:

Pediatric Medical Release Form

"I need a Pediatric Medical Release Form for my 8-year-old daughter who will be attending a three-week summer camp in Wales from July 2025, ensuring the camp staff can authorize emergency medical treatment if needed while I'm unreachable."

Document background
The Pediatric Medical Release Form is essential for situations where immediate medical decisions may be required for a minor when their parent or legal guardian is unavailable. This document, governed by English and Welsh law, provides healthcare providers with the necessary authorization to treat the child while ensuring compliance with relevant legislation including the Children Act 1989 and Data Protection Act 2018. It typically includes the child's medical history, allergies, current medications, and emergency contact information, along with specific authorizations for various types of medical treatment.
Suggested Sections

1. Child's Information: Full legal name, date of birth, NHS number, address and other identifying information of the child

2. Parent/Guardian Information: Details of all persons with parental responsibility including full names, addresses, contact numbers and relationship to child

3. Emergency Contacts: Alternative contacts to be reached when parent/guardian is unavailable, including contact details and relationship to child

4. Medical Authorization: Scope of medical treatment authorization including emergency care, routine treatments, and specific procedures

5. Consent Declaration: Formal statement of consent and understanding, including acknowledgment of rights and responsibilities

Optional Sections

1. Special Medical Conditions: Section detailing specific medical needs, allergies, chronic conditions, and special care instructions

2. Medication Authorization: Specific permissions and instructions for regular medication administration including dosage and timing

3. Religious/Cultural Considerations: Special instructions or restrictions on medical treatment based on religious or cultural beliefs

Suggested Schedules

1. Medical History Form: Comprehensive record of past medical conditions, treatments, surgeries, and ongoing health issues

2. Vaccination Record: Complete immunization history and scheduled future vaccinations

3. Insurance Information: Details of medical insurance coverage, policy numbers, and contact information for insurance providers

Authors

Alex Denne

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

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Children Act 1989: Primary legislation governing parental responsibility and child welfare in England and Wales. Key for determining who can provide medical consent for a child.

Children Act 2004: Updates and supplements the 1989 Act, focusing on the promotion of child welfare and interagency cooperation in healthcare decisions.

Mental Capacity Act 2005: Provides framework for making decisions on behalf of those lacking capacity, including young people aged 16-17.

Data Protection Act 2018 and UK GDPR: Governs how medical information and personal data must be handled, stored, and protected, including special provisions for children's data.

Access to Medical Records Act 1988: Regulates access to health records and medical information, including parental access to children's records.

Health and Social Care Act 2012: Outlines the structure of healthcare delivery and standards in England, affecting how pediatric care is provided.

Family Law Reform Act 1969: Section 8 specifically allows young people aged 16-17 to consent to medical treatment as if they were adults.

Gillick Competence: Legal principle determining whether a child under 16 has the maturity to make their own medical decisions and consent to treatment.

NHS Regulations 2015: Governs how medical services are provided within the NHS, including requirements for consent and treatment of minors.

CQC Registration Regulations 2009: Sets standards for healthcare providers, including requirements for treating children and maintaining proper documentation.

GMC Guidelines: Professional guidance from the General Medical Council on treating children and young people, including consent requirements.

BMA Guidelines: British Medical Association's professional guidance on pediatric treatment and consent procedures.

RCPCH Guidelines: Royal College of Paediatrics and Child Health guidelines on best practices for pediatric care and consent.

Teams

Employer, Employee, Start Date, Job Title, Department, Location, Probationary Period, Notice Period, Salary, Overtime, Vacation Pay, Statutory Holidays, Benefits, Bonus, Expenses, Working Hours, Rest Breaks,  Leaves of Absence, Confidentiality, Intellectual Property, Non-Solicitation, Non-Competition, Code of Conduct, Termination,  Severance Pay, Governing Law, Entire Agreemen

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