PARENTAL CONSENT FORM - Lutheran Hospital of Indiana 2026

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  1. Click ‘Get Form’ to open the PARENTAL CONSENT FORM in our editor.
  2. Begin by filling in your names as the parent(s) or legal guardian(s) at the top of the form. Ensure that both names are clearly written.
  3. Provide your address details, including city, county, and state where you reside with your child.
  4. Enter your child's name, age, and date of birth in the designated fields to identify the minor for whom consent is being given.
  5. Specify the caregiver's name and their address. This person will be authorized to make medical decisions on behalf of your child.
  6. Indicate the time period during which this consent is valid by filling in specific start and end dates.
  7. Sign and date the form at the bottom. Ensure that a witness also signs to validate the document.
  8. Fill in contact numbers for both parents/guardians and any relevant medical information about your child, including allergies and existing conditions.

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Ind. Code 16-36-1-3 provides that a minor may consent for their own health care if they are: age 14 years or older; not dependent on a parent for support; living apart from a parent or person in loco parentis; and managing their own affairs. Abortion is banned in Indiana, with very limited exceptions.
Youth age 18 years or older may consent to their own health care. Therefore parental consent is not required. Exception: For youth age 18 years or older deemed incompetent or unable to consent, DCS will obtain a court order prior to authorizing non-routine health care treatment.
Lutheran Hospital has received the American College of Cardiologys NCDR Chest Pain ̶ MI Registry Platinum Performance Achievement Award for 2025. Lutheran Hospital is one of only 323 hospitals nationwide to receive the honor.
Original 1920s Lutheran Hospital was on Fairfield Avenue. Moved to West Jefferson Boulevard in 1992. By March 5, 2001 the last of the old hospital was torn down.
Any person age of 16 or over or married may consent to routine emergency medical or surgical care. Persons under eighteen (18) years of age may give legal consent for testing, examination, and/or treatment for any reportable communicable disease.

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According to Indiana Code 35-42-4-9, the legal age of consent in Indiana is 16 years. Consequently, individuals below 16 years old lack the legal capacity to consent to any sexual activity, regardless of their explicit verbal consent.

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