An affidavit of caregiver consent for a minor's health care shall include the following:
(1) The caregiver's name and current home address;
(2) The caregiver's birth date;
(3) The relationship of the caregiver to the minor;
(4) The minor's name;
(5) The minor's birth date;
(6) The length of time the minor has resided with the caregiver;
(7) The caregiver's signature under oath affirming the truth of the matter asserted in the affidavit;
(8) The signature of the minor's parent, guardian or legal custodian consenting to the caregiver's authority over the minor's health care. The signature of the minor's parent, guardian or legal custodian is not necessary if the affidavit includes the following:
(A) A statement that the caregiver has attempted, but has been unable to obtain, the signature of the minor's parent, guardian or legal custodian;
(B) A statement that the minor's parent, guardian or legal custodian has not refused to give consent for health care and treatment of the minor child; and
(C) A description, in detail, of the attempts the caregiver made to obtain the signature of the minor's parent, guardian or legal custodian; and
(9) A statement, as follows:
"General Notices:
This declaration does not affect the rights of the minor's parent, guardian or legal custodian regarding the care, custody and control of the minor, other than with respect to health care, and does not give the caregiver legal custody of the minor.
This affidavit is valid for one year unless the minor no longer resides in the caregiver's home. Furthermore, the minor's parent, guardian or legal custodian may at any time rescind this affidavit of caregiver consent for a minor's health care by providing written notification of the rescission to the appropriate health care professional.
A person who relies in good faith on this affidavit of caregiver consent for a minor's health care has no obligation to conduct any further inquiry or investigation and is not subject to civil or criminal liability or to professional disciplinary action because of that reliance."
Structure West Virginia Code
Article 2. State Responsibilities for Children
§49-2-101. Authorization and Responsibility
§49-2-102. Minimum Staffing Complement for Child Protective Services
§49-2-103. Proceedings by the State Department
§49-2-104. Education of the Public
§49-2-105. Administrative and Judicial Review
§49-2-106. Department Responsibility for Foster Care Homes
§49-2-107. Foster-Home Care; Minimum Standards; Certificate of Operation; Inspection
§49-2-108. Visits and Inspections; Records
§49-2-109. Placing Children From Other States in Private Homes of State
§49-2-110. Development of Standards of Child Care
§49-2-111. Supervision of Child Welfare Agencies by the Department; Records and Reports
§49-2-111a. Performance Based Contracting for Child Placing Agencies
§49-2-111b. Study of Kinship Foster Care Families
§49-2-111c. Priorities for Use of Funds
§49-2-114. Application for License or Approval
§49-2-115. Conditions of Licensure, Approval and Registration
§49-2-115a. Head Start Program Licenses
§49-2-116. Investigative Authority; Evaluation; Complaint
§49-2-117. Revocation; Provisional Licensure and Approval
§49-2-118. Closing of Facilities by the Secretary; Placement of Children
§49-2-119. Supervision; Consultation; State Fire Marshall to Cooperate
§49-2-120. Penalties; Injunctions; Venue
§49-2-122. Waivers and Variances to Rules
§49-2-123. Annual Reports; Directory; Licensing Reports and Recommendations
§49-2-124. Certificate of Need Not Required; Conditions; Review
§49-2-126. The Foster Child Bill of Rights
§49-2-127. The Foster and Kinship Parent Bill of Rights
§49-2-127a. Foster and Kinship Parent Duties; Foster Parent and Kinship Parent Agreements
§49-2-128. Reasonable and Prudent Foster Parent Standard
§49-2-201. Findings and Purpose
§49-2-202. When Family Preservation Services Required
§49-2-203. Caseload Limits for Home-Based Preservation Services
§49-2-204. Situational Criteria Requiring Service
§49-2-205. Service Delivery Through Service Contracts; Accountability
§49-2-206. Special Services to Be Provided
§49-2-207. Development of Home-Based Family Preservation Services
§49-2-301. Findings and Intent; Advisory Council
§49-2-302. Creation of Statewide Quality Rating System; Rule-Making; Minimum Requirements
§49-2-401. Continuation, Transfer and Renaming of Trust Fund; Funding
§49-2-501. Children to Whom Article Applies; Intent
§49-2-502. Powers of the Secretary
§49-2-503. Report of Birth of Special Health Care Needs Child
§49-2-504. Assistance by Other Agencies
§49-2-603. Eligibility; Primary Focus
§49-2-701. Caregiver Consent for Minor's Health Care; Treatment
§49-2-702. Duty of Health Care Facility or Practitioner
§49-2-703. Affidavit of Caregiver Consent; Requirements
§49-2-704. Revocation and Termination of Consent; Written Notice; Validity
§49-2-705. Good Faith Reliance on Affidavit; Applicability
§49-2-706. Exceptions to Applicability
§49-2-707. Penalty for False Statement
§49-2-708. Rule-Making Authority
§49-2-803. Persons Mandated to Report Suspected Abuse and Neglect; Requirements
§49-2-804. Notification of Disposition of Reports
§49-2-805. Educational Programs; Requirements
§49-2-806. Mandatory Reporting of Suspected Animal Cruelty by Child Protective Service Workers
§49-2-807. Mandatory Reporting to Medical Examiner or Coroner; Postmortem Investigation
§49-2-808. Photographs and X Rays
§49-2-809. Reporting Procedures
§49-2-810. Immunity From Liability
§49-2-811. Abrogation of Privileged Communications; Exception
§49-2-812. Failure to Report; Penalty
§49-2-813. Statistical Index; Reports
§49-2-814. Task Force on Prevention of Sexual Abuse of Children
§49-2-901. Policy; Cooperation
§49-2-902. Division of Juvenile Services; Transfer of Functions; Juvenile Placement
§49-2-903. Powers and Duties; Comprehensive Strategy; Cooperation
§49-2-905. Juvenile Detention and Corrections Facility Personnel
§49-2-907. Examination, Diagnosis Classification and Treatment; Period of Custody
§49-2-909. Arrest Authority of Juvenile Correctional and Detention Officers
§49-2-911. Juvenile Benefit Funds; Uses; Reports
§49-2-912. Youth Reporting Centers
§49-2-913. Juvenile Justice Reform Oversight Committee
§49-2-1003. Rehabilitative Facilities for Status Offenders; Requirements; Educational Instruction
§49-2-1004. The Juvenile Services Reimbursement Offender Fund; Use; Expenditures