Local Juvenile Court Rule 1.11 MEDICAL CONSENT AUTHORIZATION (A) Generally. A request on behalf of a juvenile for medical authorization shall be submitted in writing. The request shall be in petition form, verified, and shall set forth the following, if known: 1. Full name of the child; 2. Date of birth of the child; 3. Child's place of residence; 4. Name of the child's father; 5. Name of the child's mother; 6. The parent's place of birth; 7. Parent's age; 8. Cultural heritage of the child; 9. Whereabouts of the parents, guardian or custodian; 10. The treatment required; 11. The reason for treatment; 12. The necessity of the authorization by the court; 13. Full names and relationship to the child of the petitioner, and; 14. Any other matter which might be relevant. (B) Emergency Requests. Emergency requests for medical consent authorization may be made by telephone and telephonically approved by the court. A record of such telephonic authorizations shall be made and a written authorization submitted for signature of the court the next judicial day. (C) Form. An appropriate form may be used to initiate such authorization. [Adopted effective April 1, 1988]
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