(a) Consent.  Consent is informed consent, requiring an explanation of the necessity for the procedure involved, any known risks involved, and, when appropriate, any alternative course of care.

• (1) Information upon which consent is based must be provided by competent medical authority for care and treatment provided by health practitioners.
• (2) Persons authorizing care and treatment must acknowledge their understanding and willingness to assume any risks associated with care and treatment.
• (3) Parents, legal guardians, legal custodians, judges, law enforcement, officers of the court, and county directors may sign the consent.
• (4) Child Welfare (CW) workers or supervisors may provide informed consent when designated in writing by the county director.
• (5) Medical procedures that are experimental are not compensable through Medicaid and must be authorized by the Oklahoma Department of Human Services (OKDHS) Director, Human Services Centers chief operating officer, or Children and Family Services Division director.

(b) Emergency medical care or treatment.  Emergency medical care or treatment is medical care or treatment provided by a qualified medical practitioner in circumstances presenting an imminent and substantial threat to a child's life or health.

(c) Extraordinary medical care or treatment.  Extraordinary medical care or treatment is medical care or treatment provided by a qualified medical practitioner using procedures or medications that are substantially invasive or restrictive or involve significant risk of harm, including, but not limited to, surgery.

(d) Ordinary medical care or treatment.  Routine physical examinations, immunizations, and treatment for minor illnesses are ordinary medical care or treatment.  Ordinary medical care includes, but is not limited to, follow-up treatment and administration of prescribed medication as directed by a qualified health practitioner, administration of non-prescription medication, and treatment of minor injuries.

(e) Due diligence.  The CW worker makes every effort to secure parental consent for medical services provided to children in emergency and temporary custody of OKDHS.  A diligent effort includes attempts to contact parents by phone to inform them of necessary medical services.  If services will be provided at a medical facility or by a medical practitioner, the parent(s) is required to contact the facility or practitioner directly.  The CW worker facilitates contact, if needed.  • 1

(f) Procedures for authorizing consent.  Procedures for authorizing consent depend on the child's custody type.

• (1) Parental agreement, voluntary foster care.  In parental agreement, voluntary foster care, the parent(s) retains legal custody of the child placed with OKDHS.
  • (A) Medical care may be authorized by the foster parent per Forms 04FC007E, Authorization from Parent or Guardian for Voluntary Foster Family Home Placement and Medical Care of Child, and 04FC011E, Placement Agreement for Out-of-Home Care.  The foster parent presents Form 04FC011E to the medical provider each time the child receives medical services.
  • (B) Due diligence is exercised to obtain parental consent for emergency or extraordinary medical care or treatment.
  • (C) If a parent or legal guardian cannot be located or refuses to consent for emergency or extraordinary care or treatment, the county director or designee authorizes the emergency care or treatment per Form 04FC007E.
  • (D) Persons in voluntary care older than age 18 provide their own consent.
  • (E) If a parent or legal guardian refuses to consent for emergency or extraordinary care, the child may be surrendered to the parent(s) or guardian or, when intervention to provide medical treatment is necessary, OAC 340:75‑3-10.1 is followed.
• (2) Child in protective custody.  Protective custody is when a child is taken into custody by a peace officer or employee of the court, without a court order because the child's surroundings endanger the child, per Section 7003-2.1 of Title 10 of the Oklahoma Statutes (10 O.S. § 7003-2.1).
  • (A) Upon admission of a child to an emergency shelter, when CW is involved, the CW worker provides the parent(s)' name, address, and work and home phone numbers, and the name, relationship, and phone number of a relative or collateral who may be contacted in an emergency.
    • (i) In a jurisdiction where the shelter designated by the court is operated by a youth services agency, the shelter obtains medical treatment as necessary.  The CW worker assists, when requested, in locating the parent(s) on cases where there has been CW involvement.
    • (ii) When medical treatment is required and information regarding the  parent(s)' whereabouts is unknown or not provided to the shelter, the CW worker may be asked to assist in locating the parent(s).
    • (iii) Upon admission to a shelter or foster home, the CW worker makes known to the caregiver the child's current legal status.
  • (B) The CW worker makes every effort to have the parent(s) sign Form 04MP001E, Consent for Release of Information, to obtain information regarding previous medical treatment from the child's and family's physician.  Any known medical history information is provided by OKDHS to the medical provider attending the child.
  • (C) Per 10 O.S. § 7003-2.3, when a child is in protective custody and appears to require medical treatment, the peace officer, employee of the court, or any other legal guardian of the child must exercise due diligence to locate the parent(s), legal guardian, or other person legally competent to authorize such treatment.  Consent of the parent(s), legal guardian, or other person legally competent to authorize such treatment is not required when:
    • (i) emergency treatment is necessary, as determined by a competent medical authority; or
    • (ii) physical examinations or routine diagnostic or evaluation procedures are necessary, as determined by a competent medical authority, to determine the medical condition of the child for protection of the child and others with whom the child may be in contact while in custody.
  • (D) If the medical treatment is for reasons other than those described in OAC 340:75-13-65(f)(2)(C), and the parent(s), legal guardian, or other person legally competent to authorize medical treatment for the child is unavailable or unwilling to consent to the treatment, the district attorney may file an application and the court must hold a hearing no later than five days after the application is filed.
  • (E) Upon presenting a child for medical treatment, the hospital or medical facility is informed of the child's custody status, and provided the name and phone number of the assigned CW worker.
  • (F) When the child requires emergency custody for the purpose of providing medical treatment, OAC 340:75-3-10.1 is followed.
• (3) Child in emergency or temporary OKDHS custody.
  • (A) Emergency custody is when the child is placed into custody prior to adjudication and following issuance of an order by the court, such as a pick-up order or at the emergency custody hearing.
  • (B) Temporary custody is when the child is in OKDHS custody following adjudication, without termination of the parent(s)' parental rights.
    • (i) 10 O.S. § 7003-7.1 and 7004-1.1 authorize OKDHS to consent to medical care and treatment for a child in emergency or temporary custody.  The foster parent may authorize ordinary medical care pursuant to Form 04FC007E.  Diligence is exercised to obtain the parent(s)' consent for extraordinary medical care or treatment, prior to authorization by OKDHS for any medical treatment.
    • (ii) When the parent(s) refuses or is unwilling to consent to the proposed treatment, and the medical treatment or procedure is not considered an emergency, the CW worker informs the parties to the deprived proceeding and the court for purposes of obtaining a hearing and court authorization for the medical treatment or procedure.
    • (iii) The county director or designee signs the consent for medical treatment when the parent(s) is unavailable and following a diligent effort to locate the parent(s) to provide consent.
    • (iv) Upon presenting a child for medical treatment, the hospital or medical facility is informed of the child's custody status and provided the name and phone number of the assigned CW worker.
• (4) Child in permanent OKDHS custody.  Permanent custody is the court‑ordered custody of a child following adjudication and whose parent(s)' parental rights have been terminated.  OKDHS has the authority to consent to the care and treatment of a child in permanent custody.
  • (A) The county director or designee signs the authorization for medical treatment.
  • (B) The foster parent authorizes routine medical care pursuant to Form 04FC007E.
  • (C) Upon presenting a child for medical treatment, the hospital or medical facility is informed that the child is in OKDHS custody and provided the name and phone number of the assigned CW worker.

(g) Consent for child in own home.  The parent(s) of a child placed in OKDHS legal custody and own home consents to ordinary medical care and treatment and hospital admission or treatment and surgery for the child.  When the facility or provider requires OKDHS authorization in addition to the parent(s)' consent, the county director or designee signs the consent forms. 

(h) Consent for emergency medical care for a child traveling out-of-state.  The county director or designee or judge, if required by the court, authorizes the foster parent to give consent for emergency medical care to a child in OKDHS custody for travel purposes via Form 04FC006E, Travel and Medical Authorization.

(i) Medical care unavailable locally.  When a child in out-of-home placement needs medical care outside the county of residence, the attending physician makes the recommendation and referral.  If the physician recommends treatment he or she cannot give, but does not make the referral, the CW worker in the county where the child is receiving care makes the appointment.