Statement of health professional Sample Clauses

Statement of health professional. I have explained the procedure to the patient. In particular, I have explained:
Sample 1Sample 2
AutoNDA by SimpleDocs
Statement of health professional.  I can confirm that the patient is aware of the benefits and adverse effects of this procedure as outlined above. Signed Date NAME
Sample 1
Statement of health professional. I have explained the procedure to the patient, in particular, I have explained: The intended benefit: Symptoms relief +/- diagnosis. The significant, unavoidable, or frequently occurring risks • Allergic reaction. • Postoperative pain, discomfort, redness and swelling. These may rarely persist long term. • Bleeding and bruising that may necessitate further treatment. • Unfavourable scarring (hypertrophic scars and keloid scars) and dyspigmentation (change of skin colour). • Postoperative infection requiring additional treatment. • Injury to nerves resulting in numbness or tingling or muscle weakness. This may persist for months, or rarely, permanently. • Incomplete resolution or recurrence – the lesion may come back. • Asymmetry and/or deformity. • Further procedures to address the original complaint or the side effects. Any extra procedures which may become necessary during the procedure. I have also discussed what the procedure is likely to involve, the benefits and risks of any available alternative treatments (including no treatment) and any particular concerns of this patient.
Sample 1
Statement of health professional. I have explained the procedure to the patient/parent. In particular, I have explained: The intended benefits: ☐ For diagnosis ☐ To remove skin cancer ☐ Other benefit: .............................……………..………………………………………………....... Serious or frequently occurring risks: Common (most patients, but usually mild or minor effects) ☐ Scar ☐ Discomfort ☐ Bruising & Swelling ☐ Numbness Uncommon (usually fewer than 1 patient in every 30 treated) ☐ Bleeding (after going home) ☐ Wound infection ☐ Incomplete removal of tumour (fewer than 1 in 50 if Mohs) ☐ Recurrence Rare (usually fewer than 1 patient in every 100 treated) ☐ Permanent numbness/altered sensation ☐ Nerve damage to muscle ☐ Unacceptable scar needing another (not expected) operation Other: .……………………….………………………………………………………………….... I have also discussed what the procedure is likely to involve, the benefits and risks of any available alternative treatments (including no treatment) and any particular patient/parent concerns. The patient/parent appears to understand. I have invited questions and these: ☐ were answered ☐ none were asked. A leaflet/video or web link was provided: ☐ Guide to Mohs micrographic surgery (NBT) Signed .…………………………………… Date ……...……………………………..... Name (PRINT) Xx Xxxx Xxxx Job title Consultant Dermatologist Statement of interpreter (where necessary) I have interpreted the information above to the patient/parent to the best of my ability and in a way in which I believe s/he/they can understand. Signed ……………….……….Date…….…………..Name (PRINT)………………………….. Statement of patient/person with parental responsibility for patient I understand and agree to the procedure described above. The procedure, alternatives and risks were explained to me in clear terms. Any questions I had were answered to my satisfaction. I was encouraged to read a leaflet/link about the procedure that I was given and I intend to do so. I understand that the procedure will involve local anaesthesia (an injection into the skin). Signature ………………………………………. Date ……………………………..……………… Name (PRINT) ………………………………… Relationship to patient ………………………… Confirmation of consent (to be completed by a health professional when the patient is admitted for the procedure, if the patient/parent has signed the form in advance) I have confirmed that the patient/parent has no further questions and wishes the procedure to go ahead. Signed: …………………………………… Date ……... ……………………………. Name (PRINT) ………………………..……….. Job title ………………………………… Copy accepted by patient:...
Sample 1
Statement of health professional. I have explained the procedure to the patient, the intended benefits of the procedure: To create access for haemodialysis. Any serious or frequently occurring risks from the procedures including those specific to the patient: Failure to mature, thrombosis or stenosis of fistula, mild to moderate steal syndrome, aneurysm of fistula, minor nerve damage, severe steal syndrome, major nerve damage, ischaemic neuropathy, compartment syndrome, bleeding, infection and deep vein thrombosis Any extra procedures that might become necessary during the procedure such as blood transfusion or other procedure (please specify) I have discussed what the treatment/procedure is likely to involve, the benefits and risks of any available alternative treatments (including no treatment) and any particular concerns of this patient. The following information leaflet has been provided: Arteriovenous Fistula as access for Haemodialysis This procedure will involve: ❑ General or Regional Anaesthesia ❑ Local Anaesthesia ❑ Sedation Health Professional’s Signature: Date: Name (PRINT): Job Title: Statement from the Patient Please read this form carefully. If your treatment has been planned, you should already have a copy, which describes the benefits and risks of the proposed treatment. If not, you will be offered one. Do ask if you have any further questions. The staff at Addenbrooke’s are here to help you. You have the right to change your mind at any time before the procedure is undertaken, including after you have signed this form. Training doctors and other health professionals is essential to the continuation of the Health Service and improving the quality of care. Your treatment may provide an important opportunity for such training, where necessary under the careful supervision of a senior doctor. You may, however, decline to be involved in the formal training of medical and other students without this adversely affecting your care and treatment. Please read the following I understand that I will have the opportunity to discuss the details of anaesthesia with an anaesthetist before the procedure unless the urgency of my situation prevents this. (This only applies to patients having general or regional anaesthesia.) I understand that you cannot give me a guarantee that a particular person will perform the procedure. The person undertaking the procedure will, however, have appropriate experience. I understand that any procedure in addition to those described on this form will only be...
Sample 1
Statement of health professional. (To be filled in by a health professional with an appropriate knowledge of the proposed procedure, as specified in the Trust’s Consent Policy) I have explained the procedure to the patient. In particular I have explained: • The intended benefits of the procedure ............................................................................................. ............................................................................................................................................................... ............................................................................................................................................................... • Any significant, unavoidable or frequently occurring risks, or risks patient thinks important ............................................................................................................................................................... ............................................................................................................................................................... ............................................................................................................................................................... This procedure will involve: 9 General and/or regional anaesthesia 9 local anaesthesia 9 sedation • Any extra procedures which may become necessary during the procedure 9 Blood product transfusion 9 Radiological procedure 9 Other procedure (please specify) ............................................................................................................................................................... • Information leaflet provided 9 (name) 9 I have offered the patient information about the procedure but s/he has refused information. I have discussed what the procedure is likely to involve, the benefits and risks of any available alternative treatments (including no treatment) and any particular concerns of this patient. I have checked that the patient has no outstanding queries and all their questions have been answered to their satisfaction. I have given them the information sheet(s) as detailed above. Health Professional’s signature .......................................................... Date:........................................ Name (PRINT): ...................................................................................... Job Title: ................................. Contact details (if patient wishes...
Sample 1

Related to Statement of health professional

  • Department of Health and Human Services An employee notified of a positive controlled substance or alcohol test result may request an independent test of their split sample at the employee’s expense. If the test result is negative, the Employer will reimburse the employee for the cost of the split sample test. An employee who has a positive alcohol test and/or a positive controlled substance test may be subject to disciplinary action, up to and including dismissal, based on the incident that prompted the testing, including a violation of the drug and alcohol free work place rules.

  • SAFETY & HEALTH The Employer and the IBTCoalition agree that the safety of employees and the general public is of utmost importance. Therefore, the Employer shall provide a safe work environment that is free of recognized hazards that could cause death, injury or illness.

  • Emergency Medical Care a. How to appropriately use Emergency Services and facilities, including a description of the services offered by the Member Services Call Center;

  • Medical Verification The Town may require medical verification of an employee’s absence if the Town perceives the employee is abusing sick leave or has used an excessive amount of sick leave. The Town may require medical verification of an employee’s absence to verify that the employee is able to return to work with or without restrictions.

  • Medical Care and Emergency Leave An employee is entitled to a leave of absence without pay because of any of the following:

  • EMPLOYEE HEALTH CARE 233. Pursuant to the Charter, the City contributes whatever rate is applicable per month directly into the City Health Service System for each employee who is a member of the Health Service System. Subsequent City contributions will be set pursuant to the Charter.

  • Occupational Health & Safety Committee (a) The Employer and the Union agree that they mutually desire to maintain standards of health and safety in the Home, in order to prevent accidents, injury and illness.

  • Health Examination 27-1 When the District determines that a MBU's health condition (mental or physical) may be impairing his/her job performance, the immediate supervisor, site administrator, or Regional Assistant Superintendent, with the concurrence of the Human Resources Department may, with just cause, direct the MBU to have a health examination at District expense. The MBU will be given a copy of the directive which will state the reason(s) for such examination. Following the examination, results will be sent by the Human Resources Department to the MBU and immediate supervisor. All communication which results from the implementation of this Article shall be handled in a confidential manner. ARTICLE TWENTY-EIGHT

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!