Before we can see a patient for medical services and treatment, we need to obtain one or more signed consent forms. These forms let us know that you want to receive our services. Only a parent, legal guardian, or legally-authorized representative may sign a consent for a patient who is a minor (less than 18 years of age), except in some unusual circumstances like emancipated minors. 

Most of the time, a child’s parent gives consent.  This includes parents of legally adopted children.  Sometimes it is a different person or agency who is the legal guardian or legally-authorized representative, and sometimes parents may not have legal authority to make health care decisions for a child.  When one of these less common situations exists, written documentation is required for us to know who can consent.  It should be brought to the appointment or sent in ahead of time.

Consent forms are usually signed at the appointment.  A parent, legal guardian or legally-authorized representative should accompany any patient under the age of 18, or any patient 18 or older who lacks legal authority to consent for themselves, to the appointment to sign consent forms for treatment and to make care decisions. Please send ahead or bring to the appointment documents of guardianship, custody, or other authority to consent and make decisions on behalf of the patient if you are not the child’s parent.  For example, grandparents, aunts, uncles, social workers, etc., must bring written documents to show that that they have authority for medical decisions for the patient, including permanent or temporary custody. Or, if you are a parent who has sole medical decision-making authority for the patient, please bring that documentation. A copy of the documentation will be added to the patient’s medical record along with required signed consent forms.

If a parent, legal guardian or other legally-authorized representative will not be available for the appointment, please contact us to make arrangements to have consent forms signed in advance. We cannot see a patient without a signed consent form on file.

Adult Consent

Adults (i.e., persons 18 years of age or older) can usually make decisions about their medical care. Before they can give consent, they must understand:

  • What the care will be, and
  • The risks and benefits of options available.

Once patients understand the proposed care, they must provide written consent before that care can begin.

Sometimes adults need help making these decisions. They may want to discuss a medical decision with family or friends. If an adult cannot make these decisions on his or her own, there are a few ways he or she can get help:

  • An individual may make an advance directive for healthcare or mental health treatment.
  • A surrogate decision-maker for healthcare can be assigned.
  • A guardian of the person may be appointed by a judge.

A.  Advance Directive for Healthcare or Mental Health Treatment

In an advance directive for healthcare or mental health treatment, the adult may name a trusted person—known as a healthcare agent—who can have immediate power to make medical decisions or when a doctor determines that the adult cannot make a decision. This can be done without going to court.

B.  Surrogate Decision-Making 

Surrogate decision-making applies when an adult needs help making healthcare decisions. Two physicians must agree that the adult cannot make his or her own decisions before a surrogate decision maker can be named. For patients treated at Kennedy Krieger Institute, it is our policy that at least one of those physicians must be employed at Kennedy Krieger. Then, a trusted adult will be chosen to help. This helper is called a surrogate. The surrogate makes decisions that are in the adult’s best interest. For outpatients, the arrangement generally lasts for one year; for inpatients, it lasts for the length of the hospitalization. The arrangement can only be used at Kennedy Krieger Institute.

For patients receiving mental health treatment and needing a surrogate decision maker – In the absence of explicit Maryland legal guidance concerning surrogate decision making for mental health treatment for individuals with intellectual, developmental, or other significant cognitive disabilities, Kennedy Krieger Institute supports such authorization in appropriate circumstances.

One of the following people (listed in order of legal preference) may be assigned as a surrogate:

  1. A guardian of the patient, if one has been chosen by the courts.
  2. The patient’s spouse.
  3. A child of the patient, if 18 years of age or older.
  4. A parent of the patient.
  5. The patient’s sister or brother, if 18 years of age or older.
  6. A person who can show that he or she is a relative or close friend of the patient, has regular contact with him or her, and is familiar with the patient’s activities, health and personal beliefs.

C.  Adult Guardianship

Adult guardianship applies when a patient cannot make healthcare decisions, and other less restrictive options are not available. There are different types of guardianship, and they all involve going to court.

We Are Here to Help

For assistance, please contact the Care Management Office, at 443-923-9400, or the Social Work Department, at 443-923-2800. Visit for information about the Health Care Decisions Act in Maryland.

If you need help regarding guardianship, contact Project HEAL (Health, Education, Advocacy and Law) at Kennedy Krieger Institute, at 443-923-4414, for appropriate referrals in your community