Purpose
The (TF) – Parental Agreement questionnaire documents acknowledgment of Tulsa Family Psychiatry & Wellness policies regarding:
- Shared parental access to health information
- Financial responsibility
- Clinical decision making for minor patients
- Expectations when parental disagreement exists
This form helps establish clear boundaries early and ensures the practice remains compliant with legal requirements while maintaining a child-centered clinical environment.
When This Form Is Used
The (TF) – Parental Agreement should be assigned when:
- A minor patient has separated, divorced, or non-cohabitating parents
- Both parents retain legal or biological parental rights
- There is known or anticipated disagreement regarding treatment or payment
- Custody or decision-making authority may be unclear
- Staff identify early signs of parental conflict affecting care
This questionnaire may be included during intake or sent later if concerns arise.
Policy Summary
The form communicates the following core principles:
Access to Health Information
- Unless restricted by court order:
- Both biological or legal parents have access to the child’s health information.
- The practice must follow applicable law.
- Any restriction requires official court documentation on file.
Staff should request and upload custody documentation when applicable.
Financial Responsibility
Parents sharing responsibility remain jointly responsible for:
- Appointment attendance
- Copays, deductibles, and balances
- Scheduling and communication related to care
The practice does not mediate financial disputes between parents.
Clinical Decision Making
Providers:
- Exercise independent clinical judgment
- Develop treatment plans based on the child’s best clinical interest
- Do not side with one parent over another
Medical decisions remain clinical, not legal determinations.
Practice Neutrality
Tulsa Family Psychiatry & Wellness:
- Will not act as a referee between parents
- Will not enforce parenting agreements
- Will cooperate with lawful requests and court orders
Active disputes should be addressed through the court system or a Guardian ad Litem, not through clinical staff.
Child-Focused Care
The policy reinforces that:
- Children should not be placed in the middle of adult conflict
- Communication should support emotional stability
The shared goal is optimal clinical and developmental outcomes
Required Documentation
If custody or decision-making authority differs from shared parental rights:
- Court order
- Custody decree
- Guardianship documentation
Documentation must be uploaded to the patient chart with an alert.