A minor may give consent to all medical, mental, dental and other health counseling and services if the minor:
1. Living separately; independent of parental support. Is living separately from parents or a legal guardian and is independent of parental support. A minor may prove that the minor meets the requirements of this subsection with documentation including, but not limited to:
A. A written statement affirming that the minor is living separately from parents or a legal guardian and is independent of parental support signed by:
(1) A director or designee of a governmental or nonprofit agency that receives public or private funding to provide services to homeless persons;
(2) A local education agency liaison for homeless children and youth designated pursuant to 42 United States Code, Section 11432(g)(1)(J)(ii) or a school social worker or counselor; or
(3) An attorney representing the minor in any legal matter;
B. A copy of a protection from abuse complaint or a temporary order or final order of protection against the minor's parent or legal guardian; or
C. Proof of filing a petition for emancipation pursuant to Title 15, section 3506‑A;
2. Married. Is or was legally married;
3. Armed Forces. Is or was a member of the Armed Forces of the United States; or
4. Emancipated. Has been emancipated by the court pursuant to Title 15, section 3506‑A.
A health care practitioner who obtains documentation that meets the requirements of this section prior to providing medical, mental, dental or other health counseling or services to a minor pursuant to this section is immune from any civil or criminal liability based on the health care practitioner's determination to provide services, except that a health care practitioner may be held liable for the health care practitioner's gross negligence or willful or wanton acts or omissions.