ROBERT L. EHRLICH, JR., Governor                             Ch. 206

(B)     A RELATIVE PROVIDING INFORMAL KINSHIP CARE FOR A CHILD MAY
CONSENT TO HEALTH CARE ON BEHALF OF THE CHILD IF:

(1)      A COURT HAS NOT APPOINTED A GUARDIAN FOR THE CHILD OR
AWARDED CUSTODY OF THE CHILD TO AN INDIVIDUAL OTHER THAN THE RELATIVE
PROVIDING INFORMAL KINSHIP CARE; AND

(2)      THE RELATIVE VERIFIES THE INFORMAL KINSHIP CARE
RELATIONSHIP THROUGH A SWORN AFFIDAVIT THAT:

(I)      MEETS THE REQUIREMENTS OF THIS SECTION; AND

(II)     IS FILED WITH A LOCAL DEPARTMENT OF SOCIAL SERVICES
THE DEPARTMENT OF HUMAN RESOURCES, SOCIAL SERVICES ADMINISTRATION.

(C)     THE AFFIDAVIT SHALL INCLUDE:

(1)      THE NAME AND DATE OF BIRTH OF THE CHILD;

(2)      THE NAME AND ADDRESS OF THE CHILD'S PARENT OR LEGAL
GUARDIAN;

(3)      THE NAME AND ADDRESS OF THE RELATIVE PROVIDING INFORMAL
KINSHIP CARE;

(4)      THE DATE THE RELATIVE ASSUMED INFORMAL KINSHIP CARE;

(5)      THE NATURE OF THE SERIOUS FAMILY HARDSHIP AND WHY IT
RESULTED IN INFORMAL KINSHIP CARE; AND

(6)      THE KINSHIP RELATION TO THE CHILD OF THE RELATIVE
PROVIDING INFORMAL KINSHIP CARE.

(D)     THE AFFIDAVIT SHALL BE IN THE FOLLOWING FORM:

(1)      I, THE UNDERSIGNED, AM OVER EIGHTEEN (18) YEARS OF AGE AND
COMPETENT TO TESTIFY TO THE FACTS AND MATTERS SET FORTH HEREIN.

(2) _____________ (NAME OF CHILD), WHOSE DATE OF BIRTH IS

___________, IS LIVING WITH ME BECAUSE OF THE FOLLOWING SERIOUS FAMILY

HARDSHIP (CHECK EACH THAT IS APPLICABLE):

____DEATH OF FATHER/MOTHER/LEGAL GUARDIAN

____SERIOUS ILLNESS OF FATHER/MOTHER/LEGAL GUARDIAN

____DRUG ADDICTION OF FATHER/MOTHER/LEGAL GUARDIAN

____INCARCERATION OF FATHER/MOTHER/LEGAL GUARDIAN

____ABANDONMENT BY FATHER/MOTHER/LEGAL GUARDIAN

____ASSIGNMENT OF FATHER/MOTHER/LEGAL GUARDIAN TO

ACTIVE MILITARY DUTY

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