Why St. Jude Needs Legal Papers for Medical Care

Before treating your child, St. Jude Children’s Research Hospital staff must make sure that they have permission. Consent (permission) can come from:

• A parent who has legal custody
• A guardian
• A legal custodian
• Another legal representative appointed by the court or a state agency 
• A power of attorney holder for health care
• A health care surrogate or agent

You should bring legal papers with you, and St. Jude may ask for them. Legal papers are papers that prove you can give permission for your child to be treated. These items show that the person who gives consent can legally do so.

Consent for medical treatment of children in Tennessee

People who can give consent for medical treatment in Tennessee include:

• A mother, including an adoptive mother if the adoption is final (unless the mother does not have legal custody)
• A father, if married to the mother when the child was born or if he has legal custody or legal authority to give consent. This includes an adoptive father if the adoption is final.
• A person with a court order for legal custody or guardianship (depending on what the order says)
• A person with power of attorney for a child younger than 18 or an adult, if the power of attorney meets legal requirements
• A person standing in loco parentis (acting in the place of a parent) under Tennessee law
• A child who is married, in the military, or has been given adult status by a court with the signed court order (an “emancipated minor”) 

When parents are not married

According to Tennessee law, a child’s mother has sole custody when the parents are not married. This is true even if:

• The child was born somewhere else
• The child’s father’s name is on the child’s birth certificate
• The father has an order of paternity
• The father is the person who takes care of the child

When the parents are not married, the child’s father may give consent only when:

• There is an emergency, and the person with custody is not available
• A court has given the father legal custody
• A court has given the father the right to consent to medical treatment
• The mother signed a power of attorney that gives the father the right to consent
• The father is in loco parentis under Tennessee law

If the child’s parents are divorced or separated, the St. Jude staff must see papers showing who has legal custody. This is true even if the child has been a St. Jude patient for a long time.

When someone else gives consent

If someone who is not a parent wants or needs to give consent, that person needs legal papers showing the authority to do so. These papers can be:

• Court orders of legal custody or guardianship
• Limited power of attorney for care of a child younger than 18
• In loco parentis affidavit
• Similar legal documents

These documents are needed even if the person is a grandparent the child lives with or someone who is adopting the child (before the adoption is final).

Legal papers to bring

Bring the most recent papers that clearly show who can make decisions and give consent for your child’s medical treatment. A request to the court (often called a “petition”) is not enough to authorize someone to give consent. The most common papers that show who can give consent are:

• A parenting plan giving legal custody, signed by a judge or chancellor
• A court order giving legal custody
• A court order appointing a guardian or conservator for a child younger than 18 or an adult
• A limited power of attorney to care for a child under 18
• Court orders that show who is not allowed to make legal decisions
• Protective and no-contact orders

When St. Jude needs legal papers

St. Jude needs legal papers if:

• Your child is under 18 and is coming to St. Jude for the first time
• There is a change in your child’s family, such as:
  • Divorce 
  • Adoption
  • New custody arrangement
  • A new court order that has been issued
• Parents are not married to each other or were not married when the patient was born 
• Someone who is not a parent needs to consent
• An adoption is not final, but the adopting parent has the right to give consent from:
  • The court
  • A biological parent 
  • A guardian
• There is a unique family situation such as imprisonment 

Bring legal papers when your child comes to St. Jude for the first time or returns to St. Jude. This speeds up registration and helps your child get to appointments on time.

Not having legal papers when you arrive could lead to delays in medical care. It is best to bring all legal papers with you just in case.

If you do not have legal papers

If you do not have legal papers with you, talk with Patient Registration or your care team about it. There may be other ways to get legal papers to the hospital if you did not bring them with you.

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