Iowa Minor (Child) Power of Attorney Form

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An Iowa minor (child) power of attorney is a form that a parent can use to authorize an agent to provide care and make decisions for their child. This power of attorney gives the chosen agent permission to access the child’s medical records, participate in school activities, provide transportation, and perform virtually any act the parent could do if they were present.

Iowa Minor (Child) Power of Attorney Form

An Iowa minor (child) power of attorney is a form that a parent can use to authorize an agent to provide care and make decisions for their child. This power of attorney gives the chosen agent permission to access the child’s medical records, participate in school activities, provide transportation, and perform virtually any act the parent could do if they were present.

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Last updated June 10th, 2024

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An Iowa minor (child) power of attorney is a form that a parent can use to authorize an agent to provide care and make decisions for their child. This power of attorney gives the chosen agent permission to access the child’s medical records, participate in school activities, provide transportation, and perform virtually any act the parent could do if they were present.

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Signing Requirements

The parent must acknowledge their signature before a notary public.[1]

Sample

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DURABLE POWER OF ATTORNEY FOR MINOR CHILD

1. Naming of Agent. I, [PARENT’S NAME], appoint the person listed below as my Agent for decisions about my minor child(ren). The person who shall act as Agent is:

Name: [AGENT’S NAME]
Address: [AGENT’S ADDRESS]

The child(ren) covered by this Power of Attorney are: [LIST EACH CHILD’S NAME AND DATE OF BIRTH].

2. Powers of Agent. My Agent has the full power and authority to manage and conduct all of my affairs related to the child(ren) listed. But, it shall not be used to override my decisions. The power and authority of my Agent shall include, but not be limited to: [DESCRIBE AGENT’S AUTHORITY].

3. Authorization to Release Information. I authorize any health care provider, health plan, laboratory, pharmacy, or insurance company, or other health clearinghouse, to release health information and medical records of the child(ren) to my Agent.

This authorization includes health information and medical records of the child(ren) for any past, present or future medical or mental health conditions.

This authorization includes information on the subject(s) marked below:

☐ Substance Abuse (alcohol/drug abuse)
☐ Mental Health as defined by Iowa Code 228.1 (includes psychological tests)
☐ HIV-Related Information (AIDS-related tests)
☐ Genetic-related information

I can revoke this authorization at any time by written notice to any provider. I have a right to inspect the disclosed information at any time. Released information may be re-disclosed and may no longer be protected by the Health Insurance Portability and Accountability Act of 1996 (HIPPA).

I give my Agent the authority to serve as the personal representative regarding the child(ren) for all purposes of HIPPA.

I authorize my Agent to sign, on behalf of the child(ren), any papers needed to implement health care decisions.

4. Effective Date and Durability. This Power of Attorney is effective [DATE OR OTHER EVENT].

This Power of Attorney shall not be affected by my disability. I may revoke this Power of Attorney by providing written notice to my Agent. If not revoked, it shall be effective until [DATE OR OTHER EVENT]. My Agent shall not be liable for an error in judgment made in good faith, but shall only be liable for willful misconduct or breach of good faith.

Parent’s Signature: _______________________
Date: ______________
Print Name: ______________
Address: _______________________

STATE OF IOWA, COUNTY OF _________________________ ) ss:

This instrument signed and acknowledged before me on this _______ day of _______________, 20____, by ________________________________.

_____________________________________
NOTARY PUBLIC FOR THE STATE OF IOWA

Sources

  1. § 633B.105