Family & personal

Parental Authorization for a Minor’s Healthcare Procedure

Private authorization limited to the stated procedure, provider, date, and contacts, without replacing clinical informed consent.

Updated on 2026-07-29

What this document is for

Record the legal representative’s administrative authorization for a specific procedure while preserving the provider’s clinical assessment and informed consent process.

Information to prepare

The fields below come from the template itself and help you check the information before filling it in.

Document details

CPF responsible person 1
Minor’s name
Minor’s date of birth
Procedure description and scope
Indicacao procedimento
Scheduled procedure date

Additional information

Alternatives, including no procedure
Possible consequences of refusal

Place, date and signatures

Name responsible person 1
Name medico ou instituicao
CRM and state
Signing city
Receipt date

How to complete and review it

Confirm the document's purpose and the requirements of the person or organization that will receive it.
Gather the supporting records and copy names, numbers, dates, and amounts exactly as they appear in the real sources.
Complete the applicable fields, review the full preview, and correct inconsistencies before exporting.
Review signatures, attachments, witnesses, deadlines, and formalities required for the specific case.

Limits and precautions

The template organizes the information provided, but it does not prove identity, authenticity, or the truth of the facts.
It does not replace an official record, professional advice, or legal, accounting, medical, or administrative review.
Acceptance, signatures, witnesses, notarization, registration, and attachments depend on the purpose, recipient, and current rules.

Legal reference stated in the template

The Brazilian reference recorded in the catalog is reproduced below in Portuguese. It is not a legal conclusion and does not replace checking the current rule. Use this statement as a starting point and check the current wording and the requirements of the specific case.

Lei nº 15.378/2026, ECA e Resolução CFM nº 2.217/2018

Where to check official information

The portals below provide broad access to public services and rules. They do not, by themselves, confirm that this template fits your case.

Questions about this template

What is Parental Authorization for a Minor’s Healthcare Procedure used for?

Record the legal representative’s administrative authorization for a specific procedure while preserving the provider’s clinical assessment and informed consent process.

What information should I prepare before filling it in?

Start with CPF responsible person 1, Minor’s name, Minor’s date of birth, Procedure description and scope, Indicacao procedimento, Scheduled procedure date. Check each item against real records before completing the document.

Does this template replace professional advice or an official record?

It does not replace an official record, professional advice, or legal, accounting, medical, or administrative review.

Do I need notarization, registration, or witnesses?

Acceptance, signatures, witnesses, notarization, registration, and attachments depend on the purpose, recipient, and current rules.