Parental Consent

If you're traveling and have to leave your children in the care of someone else, be sure they're protected. Always leave written authorization so your children can receive emergency medical treatment, if needed. For your convenience, Lutheran Health Network has provided a link for a downloadable Parental Consent Form. Simply download the form below, fill it out, and leave it with your children's caregiver. You'll need a separate, dated form for each child each time you leave town.

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LUTHERAN HEALTH NETWORK
BLUFFTON REGIONAL MEDICAL CENTER | DUKES MEMORIAL HOSPITAL | DUPONT HOSPITAL* | KOSCIUSKO COMMUNITY HOSPITAL*
LUTHERAN HEALTH PHYSICIANS | LUTHERAN HOSPITAL* | MEDSTAT | THE ORTHOPEDIC HOSPITAL* | REDIMED | REHABILITATION HOSPITAL*
ST. JOSEPH HOSPITAL*

*A physician owned hospital.