DocMuse

Delegation to take a minor to medical appointments (Italy)

Legal
Italiano
Italy
Consent
Print & sign
2 pages · 0 sold

Published byDocMuse

This document is in Italian

The PDF you download is in Italian — that is the language it has to be filed in, so it is not translated. Everything on this page is here to tell you what it says.

For parents who cannot take their child to the paediatrician, a specialist visit, a test or vaccinations and ask a grandparent, babysitter or summer camp to do it. Many surgeries, local health authorities (ASL) and hospitals have their own free delegation form: if the provider asks for it, use theirs. This Italian document lets the carer accompany the child and receive the doctor’s instructions; consent to treatment stays with the parents. Both parents sign it.

  • Made for use in Italy
  • Last updated October 14, 2026

Fill out the form

Your answers stay on this device for 7 days, or until you clear them.

0 of 0 answered

When to use this document

  • You are at work and the grandmother has to take your child to the paediatrician in Italy.
  • The babysitter will take your child for a vaccination and the surgery wants the parents' written permission.
  • Your child is at a summer camp and may need to see a doctor without you there.
  • You want to let a relative take your child to medical appointments on your behalf.

What you fill in

The details the document asks for.

  • First parent (full name)
  • First parent's codice fiscale (Italian tax code)
  • First parent's home address
  • Second parent (full name)
  • Second parent's codice fiscale (Italian tax code)
  • Second parent's home address
  • Phone number where the parents can be reached
  • Child's name
  • Child's place of birth (town, or country if abroad)
  • Child's date of birth
  • Child's codice fiscale (Italian tax code)
  • Person delegated (full name)
  • Delegate's codice fiscale (Italian tax code)
  • Delegate's relationship to the child (e.g. grandmother, babysitter)
  • What the delegation covers
  • Visits, tests or treatments (provider and dates)
  • Delegation valid until
  • City
  • Date

Common questions

Does the paediatrician or hospital in Italy already have its own delegation form?
Often it does: many paediatricians, surgeries, local health authorities (ASL) and hospitals provide their own delegation form free of charge, sometimes to be signed in front of their staff. If the provider requires it, use theirs. This document is for when there is no such form, or to entrust several visits, tests or vaccinations to a grandparent, babysitter or summer camp for a set period with one document.
Can the person delegated consent to surgery or treatment for the child?
No. Under Italian law consent to a minor’s medical treatment belongs to the holders of parental responsibility, taking the child’s wishes into account (article 3 of Law no. 219 of 22 December 2017). The carer accompanies the child, receives the doctor’s instructions and calls the parents on the number given whenever a decision goes beyond the visits and tests listed in the delegation.
Should the delegation mention the child’s illnesses or allergies?
No. The delegation only shows who may accompany the child and needs no health information. Allergies, ongoing treatment and useful reports are handed to the carer separately, in a sealed envelope, or taken along with the child’s health booklet. That way the document can be shown at reception without revealing confidential information to people who should not see it.

How you can sign this document

  • Print it and sign by hand. The signature lines in the document are left blank on purpose — sign on them in ink.
  • Sign it yourself with a qualified electronic signature. If you already hold a QES — Evrotrust, B-Trust, StampIT, ZealiD or any qualified provider on the EU Trusted List, on a card, a USB token, in a mobile app or in the cloud — our signing guide explains step by step how to sign this exact file without invalidating it. Step-by-step help, and a way to check it worked

DocMuse sells documents, not legal advice. Acceptance always depends on the recipient's rules and your local law.

Related documents

  • Notice of revocation of a power of attorney to a bank, the post office or others (Italy)

    For anyone who has revoked a power of attorney and must warn the bank, Poste Italiane, the condominium, an office or anyone else the agent dealt with. Until third parties know of the revocation, the agent’s acts can still bind you towards those acting in good faith (article 1396 of the Italian Civil Code). The letter identifies the agent and the power, asks the recipient to stop accepting the agent’s requests and to confirm receipt. Send it by PEC or recorded delivery, one per third party. Many banks also have their own form.

  • General power of attorney as a private writing (Italy)

    For anyone who wants a trusted person to handle their everyday affairs: paying bills and taxes, collecting money, picking up documents, dealing with the building’s condominium and with offices. Under Italian law a private power covers only ordinary administration and the acts expressly listed; selling or buying property, a gift or any act to be registered needs a notarial power. Banks and Poste Italiane may ask for their own forms. Signed by the principal and accepted by the agent.

  • Request for access to administrative documents (Italy)

    An Italian request, in Italian, to a public body to see or copy documents of a procedure that concerns you, under articles 22 ff. of Italian law 241/1990: it names the documents, your interest and the type of access. The body answers within 30 days. Many bodies publish a free form. No revenue stamp is needed to view documents or for plain copies; certified copies need one (16 €, from a tobacconist or with @e.bollo), and there is space to affix it. Send it by PEC or hand it in at the office.

  • Application to the Prefetto to change a first name or surname (Italy)

    For an adult Italian citizen asking to change their surname or first name, or to add one, such as the mother’s surname. The application goes to the Prefetto of the province of residence or of the one holding the birth record (article 89 of Italian Presidential Decree no. 396/2000), with the reasons and the name sought. Many Prefetture publish their own free form: if there is one, you may use it. It needs a € 16 revenue stamp (marca da bollo, from a tobacconist; online via @e.bollo or F24), except for ridiculous or shameful surnames.

  • Report of hosting a foreign national (Italy)

    An Italian written report, in Italian, that anyone who hosts a non-EU foreign national or stateless person, or lets, lends or sells them a property, must file within 48 hours with the local public security authority – the Questura or police station, or the municipality where there is no police office – even for a relative or a few days (art. 7 of Italian legislative decree 286/1998). Many Questure and municipalities have their own free form, some online: use it where it exists. Hand it in against a stamped receipt, or send it by registered post or PEC.

  • Special power of attorney for a single act (Italy)

    For anyone who cannot attend and asks a trusted person to carry out one act in their name: signing a contract, collecting a sum, representing them at a condominium meeting or before an office. The Italian power describes the act, its limits and its end date. If the act needs a special form – selling a house or a car, an act to be registered – a notarial power or a notarised signature is required. For a simple errand a delegation (delega) is enough.