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The CG5484I is a Medical Consent Authorization form used by the U.S. Coast Guard. It grants a parent or legal guardian the ability to appoint an Attorney-in-Fact to authorize medical treatment for their child in emergencies when they cannot be reached. This form facilitates timely medical decisions during critical situations, ensuring the child's health needs are prioritized even when the primary guardian is unavailable.
Gather Personal Information:
Appoint an Attorney-in-Fact:
Specify Medical Treatment Authorization:
Insurance Information:
Signature and Notarization:
Utilizing the CG5484I is crucial for families in the Coast Guard community, as it ensures that children receive necessary medical care during emergencies. By designating an Attorney-in-Fact, parents provide peace of mind that medical decisions can be made swiftly and effectively, even when they are unreachable. This proactive measure supports child safety and health care management.


The CG5484I must be completed accurately and notarized to be considered a valid legal document. It is designed to be used in compliance with the ESIGN Act, ensuring that electronic signatures hold the same legal weight as handwritten ones. This legal framework is essential for quick decision-making and minimizes the risk of delays in treatment.
When preparing to fill out the CG5484I, have the following documents at hand:
Failing to comply by not having a valid CG5484I in place can result in delays in medical treatment for the child in an emergency. Any omission or mistake in the form can render it invalid, which may consequently create legal and health-related issues. It is imperative to ensure all details are correct and up to date.
If the CG5484I does not meet specific needs, other state-specific medical consent forms may be used. While each form carries unique requirements, the principles of authorization and legal acknowledgment remain consistent. Users should verify compatibility with state laws and the Coast Guard's regulations to ensure efficacy.
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