Common Contracts
1 similar Consent for Treatment & Financial Agreement contracts
Consent for Treatment & Financial AgreementConsent for Treatment & Financial Agreement • May 25th, 2018
CONSENT FOR TREATMENT: Martha Jefferson Hospital; d/b/a Sentara Martha Jefferson Hospital or Martha Jefferson Medical Group, LLC. (“Sentara” or “Hospital”) accepts the above Patient for diagnostic testing, emergency or inpatient/outpatient treatment/surgery or telehealth services. The undersigned hereby consent(s) to Sentara providing its standard services and supplying or administering all services, supplies, medications and anesthesia ordered by Patient’s or Sentara’s physicians/assistants, and to the performance of all procedures they deem advisable, and to the disposal of removed tissues and the use of photography for clinical purposes.
