Amendment SSA1-SB82

SB82-SSA1,13,8 48.57 (3n) (g) 1. (intro.) Upon receipt of a timely petition under par. (f) the department shall give the applicant or recipient reasonable notice and an opportunity for a fair hearing. The department may make such additional investigation as it considers necessary. Notice of the hearing shall be given to the applicant or recipient and to the county department or subunit of the department whose action or failure to act, denial, or discontinuation is the subject of the petition. That county department or subunit of the department may be represented at the hearing. The department shall render its decision as soon as possible after the hearing no later than 30 days after receipt of the petition under par. (f) and shall send a certified copy of its decision to the applicant or recipient and to the county department or subunit of the department whose action or failure to act, denial, or discontinuation is the subject of the petition. The decision of the department shall have the same effect as an order of the county department or subunit of the department whose action or failure to act, denial, or discontinuation is the subject of the petition. The decision shall be final, but may be revoked or modified as altered conditions may require. The department shall deny a petition for review or shall refuse to grant relief if any of the following applies:

SB82-SSA1, s. 18 Section 18 . 48.57 (3n) (g) 2. of the statutes is amended to read:

SB82-SSA1,13,25 48.57 (3n) (g) 2. If a recipient whose payments under par. (am) are being discontinued on the grounds that an event specified in par. (am) 6. a. to f. has occurred requests a hearing within 10 days after the date of notice that his or her payments under par. (am) are being discontinued or if a recipient whose payments under par. (am) are being discontinued on the grounds that a condition specified in par. (am) 1. to 5r. does not continue to exist requests a hearing before the date on which his or her payments under par. (am) are to be discontinued, those payments may not be discontinued, except as provided in subd. 2. a. or b., until a decision is rendered after the hearing, but payments made pending the hearing decision may be recovered by the county department or department if the contested action or failure to act discontinuation is upheld. The department shall promptly notify the county department of the county in which the recipient resides or, if the recipient resides in a county having a population of 500,000 or more, the subunit of the department administering of the long-term kinship care program in that county that the recipient has requested a hearing. Payments under par. (am) shall be discontinued pending a hearing decision if any of the following applies:

SB82-SSA1, s. 19 Section 19. 48.57 (3p) (a) of the statutes is renumbered 48.57 (3p) (a) (intro.) and amended to read:

SB82-SSA1,14,3 48.57 (3p) (a) (intro.) In this subsection, "adult resident":

SB82-SSA1,14,8 1. Adult resident" means a person 18 years of age or over who lives at the home of a person who has applied for or is receiving payments under sub. (3m) or (3n) with the intent of making that home his or her home or who lives for more than 30 days cumulative in any 6-month period at the home of a person who has applied for or is receiving payments under sub. (3m) or (3n).

SB82-SSA1, s. 20 Section 20. 48.57 (3p) (a) 2. of the statutes is created to read:

SB82-SSA1,14,12 48.57 (3p) (a) 2. "Arrest" means an arrest for a violation for which the person arrested, if convicted, would be disqualified from receiving payments under sub. (3m) for a reason specified in par. (g) 1., 2., or 3.

SB82-SSA1, s. 21 Section 21 . 48.57 (3p) (d) of the statutes is amended to read:

SB82-SSA1,14,25 48.57 (3p) (d) If the person being investigated under par. (b) or (c) is a nonresident, or at any time within the 5 years preceding the date of the application has been a nonresident, or if the county department or, in a county having a population of 500,000 or more, the department of health and family services determines that the person's employment, licensing, or state court records provide a reasonable basis for further investigation, the county department or department of health and family services shall require the person to be fingerprinted on 2 fingerprint cards, each bearing a complete set of the person's fingerprints. The department of justice may provide for the submission of the fingerprint cards to the federal bureau of investigation for the purposes of verifying the identity of the person fingerprinted and obtaining records of his or her criminal arrest and conviction arrests and convictions.

SB82-SSA1, s. 22 Section 22. 48.57 (3p) (e) 4. of the statutes is amended to read:

SB82-SSA1,15,5 48.57 (3p) (e) 4. Information regarding the conviction record of the person person's record of arrests and convictions under the law of this state or any other state or under federal law. This information shall be provided on a notarized background verification form that the department shall provide by rule.

SB82-SSA1, s. 23 Section 23. 48.57 (3p) (fm) 1. of the statutes is amended to read:

SB82-SSA1,15,24 48.57 (3p) (fm) 1. The county department or, in a county having a population of 500,000 or more, the department of health and family services may provisionally approve the making of payments under sub. (3m) based on the applicant's statement under sub. (3m) (am) 4m. The county department or department of health and family services may not finally approve the making of payments under sub. (3m) unless the county department or department of health and family services receives information from the department of justice indicating that the arrest and conviction record of the applicant under the law of this state is satisfactory according to the criteria specified in par. (g) 1. to 3. does not include any arrest or conviction that the county department or department of health and family services determines is likely to adversely affect the child or the ability of the applicant to care for the child or payment is approved under par. (h) 4. The county department or department of health and family services may make payments under sub. (3m) conditioned on the receipt of information from the federal bureau of investigation indicating that the person's arrest and conviction record under the law of any other state or under federal law is satisfactory according to the criteria specified in par. (g) 1. to 3 does not include any arrest or conviction that the county department or department of health and family services determines is likely to adversely affect the child or the ability of the applicant to care for the child.

SB82-SSA1, s. 24 Section 24. 48.57 (3p) (fm) 1m. of the statutes is amended to read:

SB82-SSA1,16,24 48.57 (3p) (fm) 1m. The county department or, in a county having a population of 500,000 or more, the department of health and family services may not enter into the agreement under sub. (3n) (am) 6. unless the county department or department of health and family services receives information from the department of justice relating to the indicating that the arrest and conviction record of the applicant under the law of this state and that record indicates either that the applicant has not been arrested or convicted or that the applicant has been arrested or convicted but does not include any arrest or conviction that the director of the county department or, in a county having a population of 500,000 or more, the person designated by the secretary of health and family services to review arrest and conviction records under this subdivision determines that the conviction record is satisfactory because it does not include any arrest or conviction that the director or person designated by the secretary determines is likely to adversely affect the child or the long-term kinship care relative's applicant's ability to care for the child. The county department or, in a county having a population of 500,000 or more, the department of health and family services may make payments under sub. (3n) conditioned on the receipt of information from the federal bureau of investigation indicating that the person's arrest and conviction record under the law of any other state or under federal law is satisfactory because the conviction record does not include any arrest or conviction that the director of the county department or, in a county having a population of 500,000 or more, the person designated by the secretary of health and family services to review arrest and conviction records under this subdivision determines is likely to adversely affect the child or the long-term kinship care relative's person's ability to care for the child.

SB82-SSA1, s. 25 Section 25. 48.57 (3p) (fm) 2. of the statutes is amended to read:

SB82-SSA1,18,12 48.57 (3p) (fm) 2. A person receiving payments under sub. (3m) may provisionally employ a person in a position in which that person would have regular contact with the child for whom those payments are being made or provisionally permit a person to be an adult resident if the person receiving those payments states to the county department or, in a county having a population of 500,000 or more, the department of health and family services that the employee or adult resident does not have any arrests or convictions that could are likely to adversely affect the child or the ability of the person receiving payments to care for the child. A person receiving payments under sub. (3m) may not finally employ a person in a position in which that person would have regular contact with the child for whom those payments are being made or finally permit a person to be an adult resident until the county department or, in a county having a population of 500,000 or more, the department of health and family services receives information from the department of justice indicating that the person's arrest and conviction record under the law of this state is satisfactory according to the criteria specified in par. (g) 1. to 3. and the county department or, in a county having a population of 500,000 or more, the department of health and family services so advises the person receiving payments under sub. (3m) does not include any arrest or conviction that the county department or department of health and family services determines is likely to adversely affect the child or the ability of the person receiving payments to care for the child or until a decision is made under par. (h) 4. to permit a person who is receiving payments under sub. (3m) to employ a person in a position in which that person would have regular contact with the child for whom payments are being made or to permit a the person to be so employed or to be an adult resident and the county department or, in a county having a population of 500,000 or more, the department of health and family services so advises the person receiving payments under sub. (3m). A person receiving payments under sub. (3m) may finally employ a person in a position in which that person would have regular contact with the child for whom those payments are being made or finally permit a person to be an adult resident conditioned on the receipt of information from by the county department or, in a county having a population of 500,000 or more, the department of health and family services that from the federal bureau of investigation indicates indicating that the person's arrest and conviction record under the law of any other state or under federal law is satisfactory according to the criteria specified in par. (g) 1. to 3 does not include any arrest or conviction that the county department or department of health and family services determines is likely to adversely affect the child or the ability of the person receiving payments to care for the child.

SB82-SSA1, s. 26 Section 26 . 48.57 (3p) (fm) 2m. of the statutes is amended to read:

SB82-SSA1,20,2 48.57 (3p) (fm) 2m. A person receiving payments under sub. (3n) may provisionally employ a person in a position in which that person would have regular contact with the child for whom those payments are being made or provisionally permit a person to be an adult resident if the person receiving those payments states to the county department or, in a county having a population of 500,000 or more, the department of health and family services that, to the best of his or her knowledge, the employee or adult resident does not have any arrests or convictions that could are likely to adversely affect the child or the ability of the person receiving payments to care for the child. A person receiving payment under sub. (3n) may not finally employ a person in a position in which that person would have regular contact with the child for whom those payments are being made or finally permit a person to be an adult resident until the county department or, in a county having a population of 500,000 or more, the department of health and family services receives information from the department of justice relating to the person's indicating that the arrest and conviction record of the person under the law of this state and that record indicates either that the person has not been arrested or convicted or that the person has been arrested or convicted but does not include any arrest or conviction that the director of the county department or, in a county having a population of 500,000 or more, the person designated by the secretary of health and family services to review arrest and conviction records under this subdivision determines that the conviction record is satisfactory because it does not include any arrest or conviction that is likely to adversely affect the child or the long-term kinship care relative's ability of the person receiving payments to care for the child and the county department or department of health and family services so advises the person receiving payments under sub. (3n). A person receiving payments under sub. (3n) may finally employ a person in a position in which that person would have regular contact with the child for whom those payments are being made or finally permit a person to be an adult resident conditioned on the receipt of information from by the county department or, in a county having a population of 500,000 or more, the department of health and family services that from the federal bureau of investigation indicates indicating that the person's arrest and conviction record under the law of any other state or under federal law is satisfactory because the conviction record does not include any arrest for which a criminal charge is pending or conviction that the director of the county department or, in a county having a population of 500,000 or more, the person designated by the secretary of health and family services to review arrest and conviction records under this subdivision determines is likely to adversely affect the child or the long-term kinship care relative's ability of the person receiving payments to care for the child.

SB82-SSA1, s. 27 Section 27. 48.57 (3p) (g) (intro.) of the statutes is amended to read:

SB82-SSA1,20,13 48.57 (3p) (g) (intro.) Except as provided in par. (h), the county department or, in a county having a population of 500,000 or more, the department of health and family services may not make payments to a person applying for payments under sub. (3m) and a person receiving payments under sub. (3m) may not employ a person in a position in which that person would have regular contact with the child for whom those payments are being made or permit a person to be an adult resident if any of the following applies the person has been convicted or penalized as follows and if the county department or the department of health and family services determines that the conviction or penalty is likely to adversely affect the child or the ability of the person applying for or receiving payments to care for the child:

SB82-SSA1, s. 28 Section 28 . 48.57 (3p) (h) 1. of the statutes is amended to read:

SB82-SSA1,20,25 48.57 (3p) (h) 1. A person who is denied payments under sub. (3m) for a reason specified in par. (g) 1., 2. or 3. based on the person's conviction record, a person whose payments under sub. (3m) are discontinued based on the person's conviction record, or a person who is prohibited from employing a person in a position in which that person would have regular contact with the child for whom payments under sub. (3m) are being made or from permitting a person to be an adult resident for a reason specified in par. (g) 1., 2. or 3. based on the person's conviction record may request that the denial or discontinuation of payments or the prohibition on employment or being an adult resident be reviewed under subd. 2. Review is unavailable if the denial, discontinuation, or prohibition occurred more than 45 days before submission of the request for review.

SB82-SSA1, s. 29 Section 29. 48.57 (3p) (h) 2m. of the statutes is created to read:

SB82-SSA1,21,8 48.57 (3p) (h) 2m. If a person whose payments under sub. (3m) are being discontinued based on the person's conviction record requests a review before the date on which those payments are to be discontinued, those payments may not be discontinued, except as provided in subd. 2m. a. or b., until a decision is rendered after the review but payments made pending the review decision may be recovered by the county department or department if the discontinuation is upheld. Payments under sub. (3m) shall be discontinued if any of the following applies:

SB82-SSA1,21,10 a. The person is contesting a state law or a change in state law and not the determination of the payment made on the person's behalf.

SB82-SSA1,21,13 b. The person is notified of a change in his or her payments under sub. (3m) while the review decision is pending but the person fails to request a review of the change.

SB82-SSA1, s. 30 Section 30 . 48.57 (3p) (h) 3. of the statutes is amended to read:

SB82-SSA1,22,2 48.57 (3p) (h) 3. The director of the county department, the person designated by the governing body of a federally recognized American Indian tribe or band or, in a county having a population of 500,000 or more, the person designated by the secretary of health and family services shall review the denial or discontinuation of payments or the prohibition on employment or being an adult resident to determine if the conviction record on which the denial, discontinuation, or prohibition is based includes any arrests, convictions or penalties that are is likely to adversely affect the child or the ability of the kinship care relative person to care for the child. In reviewing the denial, discontinuation, or prohibition, the director of the county department, the person designated by the governing body of the federally recognized American Indian tribe or band or the person designated by the secretary of health and family services shall consider, but not be limited to, all of the following factors:

SB82-SSA1,22,4 a. The length of time between the date of the arrest, conviction or of the imposition of the penalty and the date of the review.

SB82-SSA1,22,6 b. The nature of the violation or penalty and how that violation or penalty affects the ability of the kinship care relative petitioner to care for the child.

SB82-SSA1,22,8 c. Whether making an exception to the denial, discontinuation, or prohibition would be is in the best interests of the child.

SB82-SSA1, s. 31 Section 31. 48.57 (3p) (h) 4. of the statutes is amended to read:

SB82-SSA1,22,23 48.57 (3p) (h) 4. If the director of the county department, the person designated by the governing body of the federally recognized American Indian tribe or band, or, in a county having a population of 500,000 or more, the person designated by the secretary of health and family services determines that the conviction record on which the denial or discontinuation of payments or the prohibition on employment or being an adult resident is based does not include any arrests, convictions or penalties that are likely to adversely affect the child or the ability of the kinship care relative person requesting the review to care for the child, the director of the county department, the person designated by the governing body of the federally recognized American Indian tribe or band, or the person designated by the secretary of health and family services may approve the making of payments under sub. (3m) or may permit a person receiving payments under sub. (3m) to employ a person in a position in which that person would have regular contact with the child for whom payments are being made or permit a person to be an adult resident.

SB82-SSA1, s. 32 Section 32. 48.57 (3p) (h) 5. of the statutes is amended to read:

SB82-SSA1,23,2 48.57 (3p) (h) 5. A decision under this paragraph is not subject to review under ch. 227 par. (hg).

SB82-SSA1, s. 33 Section 33. 48.57 (3p) (hg) of the statutes is created to read:

SB82-SSA1,23,9 48.57 (3p) (hg) 1. If on review under par. (h) a denial or discontinuation of payments under sub. (3m) or a prohibition on employment or being an adult resident is upheld, the person who requested the review may petition the department under subd. 2. for a review of that denial, discontinuation, or prohibition. Review is unavailable if the denial, discontinuation, or prohibition was upheld more than 45 days before submission of the petition for review.

SB82-SSA1,23,24 2. Upon receipt of a timely petition under subd. 1. the department shall give the petitioner reasonable notice and an opportunity for a fair hearing. The department may make such additional investigation as it considers necessary. Notice of the hearing shall be given to the petitioner and to the county department or subunit of the department whose denial, discontinuation, or prohibition is the subject of the petition. That county department or subunit of the department may be represented at the hearing. The department shall render its decision as soon as possible after the hearing and shall send a certified copy of its decision to the applicant or recipient and to the county department or subunit of the department whose denial, discontinuation, or prohibition is the subject of the petition. The decision of the department shall have the same effect as an order of the county department or subunit of the department whose denial, discontinuation, or prohibition is the subject of the petition. The decision shall be final, but may be revoked or modified as altered conditions may require. The department shall deny a petition for review or shall refuse to grant relief if any of the following applies:

SB82-SSA1,23,25 a. The petitioner withdraws the petition in writing.

SB82-SSA1,24,2 b. The sole issue in the petition concerns a change that affects an entire class of recipients and is the result of a change in state law.

SB82-SSA1,24,5 c. The petitioner abandons the petition. Abandonment occurs if the petitioner fails to appear in person or by a representative at a scheduled hearing without good cause, as determined by the department.

SB82-SSA1,24,16 3. If a person whose payments under sub. (3m) are being discontinued based on the person's conviction record requests a hearing before the date on which those payments are to be discontinued, those payments may not be discontinued, except as provided in subd. 3. a. or b., until a decision is rendered after the hearing but payments made pending the hearing decision may be recovered by the county department or department if the discontinuation is upheld. The department shall promptly notify the county department of the county in which the person resides or, if the person resides in a county having a population of 500,000 or more, the subunit of the department administering kinship care in that county that the person has requested a hearing. Payments under sub. (3m) shall be discontinued if any of the following applies:

SB82-SSA1,24,18 a. The person is contesting a state law or a change in state law and not the determination of the payment made on the person's behalf.

SB82-SSA1,24,21 b. The person is notified of a change in his or her payments under sub. (3m) while the hearing decision is pending but the person fails to request a hearing on the change.

SB82-SSA1,24,24 4. The person requesting the hearing shall be promptly informed in writing if his or her payments under sub. (3m) are to be discontinued pending the hearing decision.

SB82-SSA1, s. 34 Section 34 . 48.57 (3p) (hm) of the statutes is amended to read:

SB82-SSA1,25,10 48.57 (3p) (hm) A county department or, in a county having a population of 500,000 or more, the department may not make payments to a person under sub. (3n) and a person receiving payments under sub. (3n) may not employ a person in a position in which that person would have regular contact with the child for whom payments are being made or permit a person to be an adult resident if the director of the county department or, in a county having a population of 500,000 or more, the person designated by the secretary to review arrest and conviction records under this paragraph determines that the person has any arrest or conviction that is likely to adversely affect the child or the long-term kinship care relative's ability of the person receiving payments to care for the child.

SB82-SSA1, s. 35 Section 35 . 48.57 (3r) of the statutes is created to read:

SB82-SSA1,25,18 48.57 (3r) If the amounts in the appropriation under s. 20.435 (3) (kc) are insufficient to provide payments under sub. (3m) (am) (intro.) or (3n) (am) (intro.) to all persons who are eligible to receive those payments, the department may request the secretary of administration under s. 16.515 to supplement that appropriation for the purpose of increasing funding for those payments. Notwithstanding s. 16.515 (1), the secretary of administration may supplement the appropriation under s. 20.435 (3) (kc) if all of the following occur:

SB82-SSA1,25,21 (a) The secretary of administration determines that the amounts in the appropriation are insufficient to provide payments under sub. (3m) (am) (intro.) or (3n) (am) (intro.) to all persons who are eligible to receive those payments.

SB82-SSA1,26,2 (b) The joint committee on finance either does not schedule a meeting for the purpose of reviewing the proposed supplementation within 14 working days after the secretary of administration notifies the committee of the proposed supplementation or, if the committee schedules a meeting for the purpose of reviewing the proposed supplementation, the committee approves the proposed supplementation.

SB82-SSA1, s. 36 Section 36. 48.57 (3t) of the statutes is amended to read:

SB82-SSA1,26,14 48.57 (3t) Notwithstanding subs. (3m), (3n), and (3p), the department may enter into an agreement with the governing body of a federally recognized American Indian tribe or band to allow that governing body to administer the program under subs. (3m), (3n), and (3p) within the boundaries of that reservation. Any agreement under this subsection relating to the administration of the program under sub. (3m) shall specify the person with whom a request for review under sub. (3p) (h) 2. may be filed and the person who has been designated by the governing body to conduct the review under sub. (3p) (h) 3. and make the determination under sub. (3p) (h) 4. Any agreement under this subsection relating to the administration of the program under sub. (3n) shall specify who is to make any determination as to whether a an arrest and conviction record is satisfactory.

SB82-SSA1, s. 37 Section 37 . 48.979 of the statutes is created to read:

SB82-SSA1,26,17 48.979 Authorization to consent to health services. (1) Definitions. In this section:

SB82-SSA1,26,19 (a) "Caregiver" means an individual 18 years of age or over who resides with a child or provides temporary or permanent care and supervision for a child.

SB82-SSA1,26,20 (b) "Health care facility" has the meaning given in s. 155.01 (6).

SB82-SSA1,26,21 (c) "Health care provider" has the meaning given in s. 146.81 (1).

SB82-SSA1,26,23 (d) "Health services" means any emergency or nonemergency care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition.

SB82-SSA1,27,3 (2) Authorizing a caregiver to consent to health services. (a) A parent may authorize a caregiver to consent to health services for the parent's child by completing a health services consent form.

SB82-SSA1,27,4 (b) A valid health services consent form shall be all of the following:

SB82-SSA1,27,5 1. In writing.

SB82-SSA1,27,7 2. Dated and signed by the parent and the caregiver whom the parent is authorizing to consent to health services for the child.

SB82-SSA1,27,8 3. Voluntarily executed.

SB82-SSA1,27,12 (c) A health services consent form under this section shall remain in effect for the period of time specified on the form, which period may not exceed one year from the date on which the form is executed, unless the form is revoked or otherwise made invalid earlier.

SB82-SSA1,27,15 (d) Nothing in this section shall be construed to make invalid other instruments that are voluntarily executed by a parent authorizing an individual or other entity to consent to health services for the parent's child.

SB82-SSA1,27,22 (3) Effect of health services consent form; form. (a) Unless the health services consent form, a guardianship order, or any other court order provides otherwise, a caregiver designated in a health services consent form whom a health care provider knows is available to consent to health services for a child has priority over all other individuals other than a parent who is not currently denied periods of physical placement with the child to make health services decisions as provided in the health services consent form.

SB82-SSA1,28,6 (b) The department shall prepare the health services consent form and accompanying information. The department shall include, in information accompanying the form, at least the statutory definitions of the terms used in the form. The department shall prepare the form and accompanying information in English, Spanish, and other languages spoken by a significant number of state residents, as determined by the department. The department shall make the health services consent form available at no charge on the Internet. The health services consent form prepared by the department shall be in substantially the following form:

SB82-SSA1,28,7 HEALTH SERVICES CONSENT

SB82-SSA1,28,11 Use of form: Use of this form is voluntary, but completion of the form will aid the caregiver of a child in ensuring that appropriate and timely health care is provided for the child. The form is to be completed by the parent of a child who resides with another adult or who is being cared for by another adult.

SB82-SSA1,28,13 Instructions: If additional space is needed, attach a separate sheet or use reverse side of this form.

SB82-SSA1,28,15 AUTHORIZATION TO CONSENT TO HEALTH SERVICES

SB82-SSA1,28,19 I, .... (print name of parent), hereby authorize my child's caregiver .... (print name of caregiver), who currently resides with or is providing care for (cross out "currently resides with or" or "or is providing care for," if inapplicable) my child, .... (print name and date of birth of child), to do the following for my child:

SB82-SSA1,28,20 A. Health Services Consent and Exclusions:

SB82-SSA1,28,24 Provide consent for emergency and nonemergency health services for my child, .... (print name of child), including medical and dental examinations and prescribed treatments, including surgery, with the following exceptions: (If there are no exceptions, write "none.")

SB82-SSA1,29,1 ........................................................................................................................................

SB82-SSA1,29,2 ........................................................................................................................................

SB82-SSA1,29,4 All health services will be provided under the direction of a licensed dental care provider or physician or other licensed health care provider as appropriate.

SB82-SSA1,29,7 B. Child's Health Care Records. Provide consent to the release of the patient health care records of my child, .... (print name of child), with the following exceptions: (If there are no exceptions, write "none.")

SB82-SSA1,29,8 ........................................................................................................................................

SB82-SSA1,29,9 ........................................................................................................................................

SB82-SSA1,29,13 The authority granted under this health services consent form shall remain in effect until .... (print date), unless revoked or made invalid earlier. (The parent may specify any date agreed to between the parent and caregiver up to one year after the date on which the form is signed.)

SB82-SSA1,29,14 Signature of parent .... Date ....

SB82-SSA1,29,15 Name of parent (print) ....

SB82-SSA1,29,16 STATEMENT OF CAREGIVER

SB82-SSA1,29,22 I understand that .... (name of parent) has authorized me to make health services decisions for .... (name of child). I agree to make health services decisions for the above-named child consistent with what I and the child's health care providers believe is in the child's best interest, consistent with the authority granted in this form, and consistent with any other wishes or beliefs of the child's parent of which I am aware.

SB82-SSA1,29,23 Signature of Caregiver .... Date ....