Forms
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We are your resource
Below, are forms and templates you may find helpful in managing your child’s healthcare.
Application for Professional Counseling
Critically Loved never wants finances to be a hindrance for families with critically and chronically ill children to receive the help they need! Any child that is diagnosed with a medical, behavioral or developmental condition and lives in the greater Louisville, KY area, may qualify. Since we know a child’s serious health condition affect the entire family, we also offer professional counseling for siblings and parents as well!
Medical Summary Template
It is helpful to keep several copies of your child’s Medical Summary in their Medical Binder. When seeing a new doctor, have new staff at doctor’s office or are in an emergency situation, you will need their Medical Summary.
Consent for Medical Treatment
EACH STATE HAS THEIR OWN FORM. Please check with your state health department for the applicable form. Also, be sure to check with your local hospitals and doctors to see if you need different wording on the medical consent. Some healthcare providers may require a form only obtained at their facility, so check with your child’s providers. In addition, be sure to make a copy of the front and back of your child’s medical insurance card and attach it to the Medical Consent. The one below is ONLY FOR KENTUCKY RESIDENTS.
Our mission
“Critically Loved exists to provide guidance and hope for families of chronically or critically ill children.”
We are in this together
Much Love
“Love always protects, always trusts, always hopes, always perseveres.”
1 Corinthians 13:7