Statement of interpreter Sample Clauses

Statement of interpreter. (where appropriate) I have interpreted the information above to the patient to the best of my ability and in a way in which I believe she/he can understand. Signed....................................................................................... Date.................................................. Name (PRINT).........................................................................................................................................
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Statement of interpreter. (where appropriate) I have interpreted the information above to the patient to the best of my ability and in a way in which I believe she/he can understand. Signed ............................................................................................................... Date .................................................... Name (PRINT) ..................................................................................................................................................................... Copy accepted by patient: yes / no (please ring) YELLOW COPY: CASE NOTES WHITE COPY: PATIENT Statement of parent Please read this form carefully. If your child’s treatment has been planned in advance, you should already have your own copy, which describes the benefits and risks of the proposed treatment. If not, you will be offered a copy now. If you have any further questions, do ask - we are here to help. You and your child have the right to change your mind at any time, including after you have signed this form. I agree to the procedure or course of treatment described on this form and I confirm that I have ‘parental responsibility’ for this child. I understand that you cannot give me a guarantee that a particular person will perform the procedure. The person will, however, have appropriate experience. I understand that where applicable, my child and 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 children having general anaesthesia.) I understand that any procedure in addition to those described on this form will only be carried out if it is necessary to save the life of my child or to prevent serious harm to his or her health. I have been told about additional procedures which may become necessary during my child’s treatment. I have listed below any procedures which I do not wish to be carried out without further discussion even if my child becomes at risk of death ................................................................................................................................................... ............................................................................................................................................................................................ I consent/do not consent to the removal of my tissue and/or blood products during this operation and I consent/do not consen...
Sample 1

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