Form KDOC-0091 "Consent to Medical Care - Director" - Kansas

What Is Form KDOC-0091?

This is a legal form that was released by the Kansas Department of Corrections - a government authority operating within Kansas. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2006;
  • The latest edition provided by the Kansas Department of Corrections;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form KDOC-0091 by clicking the link below or browse more documents and templates provided by the Kansas Department of Corrections.

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Download Form KDOC-0091 "Consent to Medical Care - Director" - Kansas

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STATE OF KANSAS
KDOC
CONSENT TO MEDICAL CARE
I, ______________________________________________________________legal custodian of
__________________________, born (month, day, year)_______________________________,
do hereby consent to any medical or surgical care and the administration of anesthesia
determined by a physician to be necessary for the welfare of _____________________________
while said juvenile is under the care, custody and control of the Secretary of the Kansas
Department of Corrections.
__________________________________
Legal Custodian,
Community Supervision Agency Director
State of ________________________
County of ______________________
Now on this ______________ day of ________________, 20 ___, before me, a Notary Public, in
and for the aforesaid state, personally appeared the person who has signed this instrument in
writing, and such person has, in my presence, duly acknowledged the execution and signing of
the same to be his/her voluntary act and deed.
______________________________
Notary Public
My commission expires ________________.
This consent is given in accordance with K.S.A. 38-2316 (see page 2)
State of Kansas
Page 1 of 2
Kansas Department of Corrections
Form KDOC-0091
Rev. May 2006
STATE OF KANSAS
KDOC
CONSENT TO MEDICAL CARE
I, ______________________________________________________________legal custodian of
__________________________, born (month, day, year)_______________________________,
do hereby consent to any medical or surgical care and the administration of anesthesia
determined by a physician to be necessary for the welfare of _____________________________
while said juvenile is under the care, custody and control of the Secretary of the Kansas
Department of Corrections.
__________________________________
Legal Custodian,
Community Supervision Agency Director
State of ________________________
County of ______________________
Now on this ______________ day of ________________, 20 ___, before me, a Notary Public, in
and for the aforesaid state, personally appeared the person who has signed this instrument in
writing, and such person has, in my presence, duly acknowledged the execution and signing of
the same to be his/her voluntary act and deed.
______________________________
Notary Public
My commission expires ________________.
This consent is given in accordance with K.S.A. 38-2316 (see page 2)
State of Kansas
Page 1 of 2
Kansas Department of Corrections
Form KDOC-0091
Rev. May 2006
Kansas Juvenile Offender Code
(a) Physical care and treatment. (1) When the health or condition of a juvenile who is
38-2316.
subject to the jurisdiction of the court requires it, the court may consent to hospital, medical,
surgical or dental treatment or procedures including the release and inspection of medical or
dental records.
(2) When the health or condition of a juvenile requires it and the juvenile has been placed in
the custody of the commissioner or a person other than a parent or placed in or committed to a
facility, the custodian or an agent designated by the custodian shall be the personal representative
for the purpose of consenting to disclosure of otherwise protected health information and have
authority to consent to hospital, medical, surgical or dental treatment or procedures including the
release and inspection of medical or dental records, subject to terms and conditions the court
considers proper. A juvenile or parent of a juvenile who is opposed to certain medical procedures
authorized by this section may request an opportunity for a hearing thereon before the court.
Subsequent to the hearing, the court may authorize or limit the performance of the proposed
treatment subject to the terms and conditions the court considers proper. The provisions of this
subsection shall also apply to juvenile felons, as defined in K.S.A. 38-16,112, prior to its repeal,
and juveniles in the custody of the department of corrections pursuant to K.S.A. 2006 Supp. 38-
2366, and amendments thereto, who have been placed in a juvenile correctional facility pursuant
to K.S.A. 75-5206, and amendments thereto.
(3) Any health care provider, who in good faith renders hospital, medical, surgical or dental
care or treatment to any juvenile after a consent has been obtained as authorized by this section,
shall not be liable in any civil or criminal action for failure to obtain consent of a parent.
(4) Nothing in this section shall be construed to mean that any person shall be relieved of
legal responsibility to provide care and support for a juvenile.
(b) Mental care and treatment. If it is brought to the court's attention, while the court is
exercising jurisdiction over a juvenile under this code, that the juvenile may be a mentally ill
person as defined in K.S.A. 59-2946, and amendments thereto, the court may:
(1) Direct or authorize the county or district attorney or the person supplying the information
to file the petition provided for in K.S.A. 59-2957, and amendments thereto, and proceed to hear
and determine the issues raised by the application as provided in the care and treatment act for
mentally ill persons; or
(2) Authorize the juvenile to seek voluntary admission to a treatment facility as provided in
K.S.A. 59-2949, and amendments thereto.
The application to determine whether the juvenile is a mentally ill person may be filed in the
same proceedings as the petition alleging the juvenile to be a juvenile offender or may be
brought in separate proceedings. In either event, the court may enter an order staying any further
proceedings under this code until all proceedings have been concluded under the care and
treatment act for mentally ill persons.
State of Kansas
Page 2 of 2
Kansas Department of Corrections
Form KDOC-0091
Rev. May 2006
Page of 2