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PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1186-1195

CLINICAL REPORT

Consent by Proxy for Nonurgent Pediatric Care

Jan Ellen Berger, MD, MJ and Committee on Medical Liability

Minor-aged patients are often brought to the pediatrician for nonurgent acute medical care or health supervision visits by someone other than their custodial parent or guardian. These surrogates can be members of the child’s extended family, such as a grandparent or aunt. In cases of divorce and remarriage, a noncustodial parent or stepparent may accompany the patient. Sometimes, children are brought for care by adults living in the home who are not biologically or legally related to the child. In some instances, a child care professional (eg, au pair, nanny) brings the pediatric patient for medical care. This report identifies common situations in which pediatricians may encounter "consent by proxy" for nonurgent medical care for minors and explains the potential for liability exposure associated with these circumstances. The report suggests practical steps that balance the need to minimize the physician’s liability exposure with the patient’s access to health care. Key issues to be considered when creating or updating office policies for obtaining and documenting consent by proxy are offered.

Abbreviations: AAP, American Academy of Pediatrics • VICP, Vaccine Injury Compensation Program • VIS, vaccine information statement




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