Maricopa County's Authorization to Use and Disclose Protected Health Information. A grandparents' medical consent form allows a parent or legal guardian to hand over all responsibility regarding their child's healthcare decisions.I give permission for the administration of the medication, according to the instructions listed, to the child listed above. Date of authorization:. Parent Consent and Emergency Information. Please fill out the form below. How to fill out the Grandparent Medical Consent Form for Minors? Fill in the fields on the Request for Information form, then click the Submit button at the bottom of that page to submit your request. Click below or call 866-637-5341 to check eligibility.