How to Get a Child to the Doctor in New Hampshire Without Custody Papers

If you're caring for a child in New Hampshire and need to get them to a doctor without custody papers, you have more authority than most front-desk staff realize. For emergency medical services, RSA 153-A:18 provides limited protection when the child cannot consent, no legally authorized consent-giver is reasonably available, and the provider acts in good faith. For non-emergency care (a pediatric checkup, vaccinations, a dental cleaning), a temporary agent delegation under RSA 461-A:19-a gives you documented consent authority without a court order, without an attorney, and without a notary when an eligible parent or guardian can appoint you and all statutory conditions are met. You can execute it today if an eligible parent or guardian is available to sign.

The hard part isn't the law. It's the clinic intake desk.

The Three Levels of Medical Consent Authority

Level 1: Emergency care when consent cannot be obtained

RSA 153-A:18 protects an emergency medical care provider or health professional from civil liability based solely on failure to obtain consent when the patient cannot consent (including because of minority), no other person reasonably available is legally authorized to consent, and the provider acts in good faith. New Hampshire EMS protocols say crews should try to contact a parent or legal guardian except in life-threatening emergencies. When a parent or guardian is unavailable, another representative expressly authorized by the parent or an adult family member with custody may consent.

Level 2: Temporary agent delegation (covers routine care)

RSA 461-A:19-a lets an eligible parent or guardian delegate powers they hold regarding the child's care, custody, or property for up to 60 days. The writing must be signed by the parent(s) or guardian(s), attested by two adult witnesses (both at least 18, neither of whom is you), and accepted by you in writing. If there is no parenting plan and another living parent is known and willing and able to safely provide care and custody, that parent's written consent is required unless a statutory exception applies. The statute also bars appointments in specified court-placement and DCYF-investigation situations. No notarization is required.

When you present this at a pediatric office, you're showing them a delegation backed by a specific New Hampshire statute. That's different from handing them a generic "medical consent form" downloaded from a document site — those forms frequently cite the wrong statute or reference laws that New Hampshire doesn't have.

Level 3: Court-ordered guardianship (broader authority)

A guardian under RSA 463 has the powers and responsibilities of a parent regarding the child's support, care, and education, including consent for medical care, subject to statutory and court-ordered limits. This requires a court petition, filing fees, and a hearing. The advantage is broader authority with no 60-day limit; the guardianship can still be modified or terminated by the court and generally ends when the child turns 18. The tradeoff is time — weeks to months — and cost.

What to Bring to the First Appointment

Walk into the pediatric or dental office with these items ready:

• The executed temporary agent delegation with the RSA 461-A:19-a citation visible
• Your government-issued photo ID
• The child's insurance card (Medicaid, the parent's insurance, or documentation that you're applying for Medicaid through NH EASY)
• Whatever medical history you have — immunization records, allergies, medications, previous diagnoses
• The names and contact information for the child's previous healthcare providers, if known

If you don't have the child's insurance information, that's not a barrier to the appointment. Tell the office you're in the process of establishing coverage. Medicaid eligibility for a child in informal kinship care doesn't require a custody order — you can apply through the NH EASY portal.

When the Clinic Says No

Pediatric offices and dental clinics in New Hampshire sometimes refuse to see a child presented by a caregiver without "custody papers." This happens because front-desk staff follow internal policies that are stricter than what the law requires. A valid temporary agent delegation under RSA 461-A:19-a is a legally recognized instrument — but the receptionist may not have seen one before.

What to do:

1. Ask which specific document or legal authority the clinic requires. Get the answer in writing or take notes.
2. Show the delegation and point to the RSA 461-A:19-a citation. Many offices will accept it once they see the statutory reference.
3. Ask to speak with the office manager or patient advocate. Front-desk staff may not have authority to make exceptions to their enrollment checklist.
4. If the office still refuses, contact 603 Legal Aid for guidance. A brief phone call from a legal advocate to the office often resolves the impasse.

The refusal pattern is real but not universal. Many New Hampshire providers routinely see children brought by grandparents and other relatives. If your first choice of provider won't cooperate, a federally qualified health center (FQHC) — there are several across New Hampshire — is often more experienced with non-traditional custody arrangements.

Special Consent Situations

Not every medical decision falls neatly under "routine care."

Vaccinations: A temporary agent may consent to immunizations if the parent or guardian delegated that authority. However, some providers treat vaccinations as requiring explicit parental consent, especially for elective vaccines. School admission requires immunization, partial immunization allowed under DHHS rules, or a statutory exemption under RSA 141-C:20-a; it does not necessarily require every vaccine for every child.

Mental health and therapy: House Bill 114, the 2023 proposal to let minors age 16 or older consent to mental health services, failed in the Senate. RSA 318-B:12-a also says it does not make a sufficiently mature minor legally incapable of consenting to medical treatment. Confirm with the provider whether that rule applies to the specific outpatient mental health service. A temporary agent delegation covers referrals and appointments, but ongoing therapy decisions may prompt a provider to request court-ordered guardianship for longer treatment plans.

Substance use treatment: A different rule applies. Under RSA 318-B:12-a, minors aged 12 and older can consent to their own drug dependency treatment without parental consent or financial liability. You don't need a delegation for this — the minor consents directly.

STI testing and treatment: RSA 141-C:18, II allows minors aged 14 or older to seek diagnosis and treatment for sexually transmitted infections without parental consent or knowledge.

FANF and Medicaid for the Child

If the child doesn't have health insurance, you can apply for Medicaid through the NH EASY online portal without a custody order. A child in informal kinship care may also be eligible for a FANF (Financial Assistance for Needy Families) child-only grant, which doesn't count your income — only the child's income. The application doesn't require you to have guardianship, and the benefits help cover the cost of the very medical care you're trying to access.

The School and Medical Consent for Grandparents and Relatives in New Hampshire covers the full medical consent pathway: executing the temporary agent delegation with a step-by-step checklist, the Medical Intake Preparation Worksheet with everything to bring to the first appointment, the escalation protocol for reluctant providers, teen self-consent boundaries, insurance and benefits eligibility, and the Authority Document Expiration Tracker so the 60-day delegation doesn't lapse while the child still needs follow-up care.

Frequently Asked Questions

Can I take my grandchild to the ER without custody in New Hampshire?

For emergency medical services, RSA 153-A:18 provides limited protection when a child cannot consent and no legally authorized person is reasonably available. EMS protocols say crews should try to contact a parent or legal guardian unless the emergency is life-threatening. If the parent or guardian is unavailable, an expressly authorized representative or an adult family member with custody may consent.

What if the parent won't sign a temporary agent delegation?

If the parent refuses to delegate authority and the child needs non-emergency medical care, a guardianship petition under RSA 463 may be needed to obtain formal authority. Under RSA 463:7, an ex-parte order requires sworn facts showing that the child will or is likely to suffer immediate or irreparable harm without relief. It expires after 30 days unless the court extends it pending notice after a due and diligent effort to provide the required names and addresses, with an express finding that the child remains at risk. 603 Legal Aid provides free representation for qualifying families.

Does Medicaid require custody to cover a child living with a grandparent?

No. A child in informal kinship care can qualify for Medicaid based on the child's own eligibility, not the caregiver's custody status. Apply through the NH EASY portal. The FANF child-only grant is another option — it considers the child's income, not your household income.

Can a dentist refuse to clean my grandchild's teeth without a court order?

A dentist can set their own office policy about which documentation they require, but New Hampshire law does not mandate a court order for routine dental care when you hold a valid temporary agent delegation under RSA 461-A:19-a. If a dental office refuses, ask to speak with the office manager, present the delegation with the statutory citation, and if they still decline, a federally qualified health center or another dental practice may be more accommodating.

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