Form Dcf F Cfs0997 is a legal document that deals with the financial support of a child. It can be used to create and amend agreements between parents regarding child support payments. This form may also be used in paternity or divorce proceedings. The document must be filed with the court in order to become legally binding. In addition, both parents must sign the form for it to be valid. The purpose of this form is to ensure that children receive the financial support they need from their parents. Nowadays, more and more families are breaking down, which often means that one or both parents have to take on the role of supporting a child financially. This can place a lot of stress on those individuals, so it's important that there is a formal agreement in place specifying who will pay what when it comes to raising a child. Form Dcf F Cfs0997 goes a long way towards ensuring that children don't go without the basic necessities in life just because their parents are no longer together
| Question | Answer |
|---|---|
| Form Name | Form Dcf F Cfs0997 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | yyyy, DCF-F-CFS0997, nonemergency, immunizations |
DEPARTMENT OF CHILDREN AND FAMILIES
Division of Safety and Permanence
MEDICAL SERVICES CONSENT
Use of form: Use of this form is voluntary, but completion will aid caretakers in ensuring that appropriate and timely health care is provided. The form is to be completed by the parent or guardian of a child placed in foster care or treatment foster care. Personally identifiable information on this form will be used for identification purposes and to assure appropriate medical care for the child. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m), Wisconsin Statutes].
Instructions: If additional space is needed, attach a separate sheet or use reverse side of this form.
Name – Parent or Guardian (Last, First, MI)
Name – Child (Last, First, MI)
Birthdate – Child (mm/dd/yyyy)
A. Routine Medical Services Consent and Exclusions
For purposes of routine medical services for the above named child, I hereby give my consent for the child placing agency or its designee to approve the provision of routine medical services*, including medical and dental examinations and nonemergency prescribed treatments (e.g., tooth repair, immunizations, medications, reproductive health needs assessment), with the following exceptions:
* All medical services will be under the direction of a licensed dental care provider or physician or other licensed professional as appropriate.
B. Routine Emergency Medical Services Consent and Exclusions
In case of a medical emergency involving the above named child, I understand that the following procedures will be used. I hereby give my consent for the child placing agency or its designee to arrange for emergency medical services using the following procedures:
1.A reasonable effort will be made to contact me and secure my consent for needed medical services, including surgical procedures.
2.If I cannot be located within a reasonable time, the placing agency has the authority to consent to emergency surgery.
3.The juvenile court has the authority to consent to other medical services.
4.All medical services will be under the direction of a licensed dental care provider or physician or other licensed professional as appropriate.
I have no objections to the placing agency exercising its authority, with the following exceptions:
C. Parent / Guardian Information
Address – Home (Street, City, State, Zip Code)
Telephone Number – Home
Address – Work (Street, City, State, Zip Code)
Telephone Number – Work
Address – Other (Specify)
Telephone Number – Other (Specify)
Address – Other (Specify)
Telephone Number – Other (Specify)
SIGNATURE – Parent / Guardian
Date Signed
SIGNATURE – Child (age 14 and over only)
Date Signed