Consent Forms

Certain procedures or tests require particular forms of patient consent. You can access those consent forms here.

Hospital Visits

• General Consent to Hospital Treatment (English, Form 30045, Rev 9/22)
• General Consent to Hospital Treatment (Spanish, Form 30044, Rev 9/22)
• Authorization to Obtain Medical Treatment (Form 30630, Rev 4/17)
• In Loco Parentis Affidavit (Form 32188, Rev 6/20)

Primary Care and Specialty Care Visits

• Parent / Guardian's Consent for Treatment, Information Sharing, and Financial Agreement (Form 31647, Rev 5/20)
• Consentimiento de paciente adulto para tratamiento, divulgación de información y acuerdo de pago (Adult Patient Consent)  (Spanish, Form 31666, Rev 1/17)
• Adult Patient Consent for Treatment, Information Sharing, and Financial Agreement (English, Form 31648, Rev 12/20)
• In Loco Parentis Consent to Treat (Form 31646, Rev 6/20)
• In Loco Parentis Affidavit (Form 32188, Rev 6/20)

For Remote Services

• Consent to Medical Treatment via Remote Communication Technology (English, Form 32716, Rev 4/20)
• Consentimiento para Tratamiento Médico por Tecnología de Comunicación Remota (Spanish, Form 32688, Rev 1/20)