COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • December 16th, 2020
I, the undersigned patient, consent to an in-person consultation and/or to have my Doctor and/or his/her staff (hereinafter collectively “my Doctor”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID-19 pandemic and after. I understand in-person consultations and/or having my procedure performed at this time, despite my own efforts and those of my Doctor, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, whether performed in my Doctor’s office or in a hospital, may result in a more severe case of COVID-19 than I might have had without the procedure.
COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • August 29th, 2022
I, the undersigned patient, consent to have Dr. Phillip Dauwe and his staff (hereinafter collectively “my Doctor”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID-19 pandemic and after. I understand having my procedure performed at this time, despite my own efforts and those of my Doctor, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, whether performed in my Doctor’s office or in a hospital, may result in a more severe case of COVID-19 than I might have had without the procedure.
COVID-19 Informed Consent Agreement 2021Covid-19 Informed Consent Agreement • March 15th, 2021
We have been evaluating the effects of the COVID-19 pandemic on Camp operations and exploring the feasibility of providing a quality camping experience this summer.
COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • October 19th, 2021
Risk of Exposure. I, the undersigned individual, consent to an in-person consultation and/or to have my Doctor and/or his/her staff (hereinafter collectively “my Doctor”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID-19 pandemic and after. I understand in-person consultations and/or having my procedure performed at this time, despite my own efforts and those of my Doctor, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, whether performed in my Doctor’s office or in a hospital, may result in a more severe case of COVID-19 than I might have had without the procedure.
COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • October 28th, 2020
Risk of Exposure. I, the undersigned individual, consent to an in-person office visit and/or to have my Doctor and/or his/her staff (hereinafter collectively “my Doctor”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID-19 pandemic and after. I understand in-person consultations and/or having my procedure performed at this time, despite my own efforts and those of my Doctor, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, whether performed in my Doctor’s office or in a hospital, may result in a more severe case of COVID-19 than I might have had without the procedure.
USC Recreational Sports: USC Club Sports/USC Intramural Sports COVID-19 Informed Consent AgreementCovid-19 Informed Consent Agreement • March 29th, 2021
The State of California recently announced that effective February 26, 2021, moderate-contact and high- contact adult recreational sports may resume, including competitions, if permitted by local health authorities and if in compliance with both Los Angeles County and State requirements for these sports.
COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • May 14th, 2020
I, the undersigned patient, consent to have my Doctor and/or his staff (hereinafter collectively “my Doctor”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID- 19 pandemic and after. I understand having my procedure performed at this time, despite my own efforts and those of my Doctor, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, whether performed in my Doctor’s office or in a hospital, may result in a more severe case of COVID-19 than I might have had without the procedure.
Waverly, TNCovid-19 Informed Consent Agreement • April 28th, 2022
The Covid-19 Informed Consent Agreement must be signed and returned with the Volunteer Registration form at least 2 weeks before arriving at the project location. The most recent Covid-19 Informed Consent Agreement can be found on the relevant project page or under “Forms & Guidelines”.
COVID-19 INFORMED CONSENTCovid-19 Informed Consent Agreement • February 4th, 2022
The novel coronavirus (COVID-19) has been declared a global pandemic by the World Health Organization (WHO). COVID-19 is extremely contagious and may be contracted through various sources. COVID-19 has a long incubation period during which carriers of the virus might not show symptoms while still being contagious.
Banff Sport Medicine COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • February 5th, 2022
At Banff Sport Medicine we believe that all patients should be well informed about their surgery. Your surgeon would have explained the risks of your particular surgery to you at the time of your assessment, and these are also outlined in your surgery paperwork and on our website (www.banffsportmed.ca). With the COVID-19 pandemic there are some risks related to the virus that you should know about to be fully informed. We believe it is safe to proceed with your surgery and are following all recommended guidelines.
Coastal, NCCovid-19 Informed Consent Agreement • January 14th, 2022
The Covid-19 Informed Consent Agreement must be signed and returned with the Volunteer Registration form at least 2 weeks before arriving at the project location. The January 2022 updated Covid-19 Informed Consent Agreement can be found on the relevant project page or under “Forms & Guidelines”.
Parks & Recreation Department COVID – 19 Informed Consent AgreementCovid-19 Informed Consent Agreement • August 16th, 2021
In accordance with the state and county guidelines the City has implemented an informed consent form and its guidelines while using the City facility. The guidelines noted below are designed to limit the spread of COVID-19.
Banff Sport Medicine COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • November 26th, 2020
At Banff Sport Medicine we believe that all patients should be well informed about their surgery. Your surgeon would have explained the risks of your particular surgery to you at the time of your assessment, and these are also outlined in your surgery paperwork and on our website (www.banffsportmed.ca). With the COVID-19 pandemic there are some risks related to the virus that you should know about to be fully informed. We believe it is safe to proceed with your surgery and are following all recommended guidelines.
Coastal, NCCovid-19 Informed Consent Agreement • July 30th, 2021
The Covid-19 Informed Consent Agreement must be signed and returned with the Volunteer Registration form at least 2 weeks before arriving at the project location. The Covid-19 Informed Consent Agreement can be found on the relevant project page or under “Forms & Guidelines”.
COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • May 3rd, 2020
I, the undersigned patient, consent to have Dr. Binstock, Dr. Layton or S. Cullinane PA-C, and/or his/her staff (hereinafter collectively “my Doctor”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID-19 pandemic and after. I understand having my procedure performed at this time, despite my own efforts and those of my Doctor, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, may result in a more severe case of COVID-19 than I might have had without the procedure, in the event I currently have or should in the future acquire the COVID-19 infection.
COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • October 23rd, 2020
I, the undersigned patient, consent to have my Doctor and/or his/her staff (hereinafter collectively “my Doctor”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID-19 pandemic and after. I understand having my procedure performed at this time, despite my own efforts and those of my Doctor, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, whether performed in my Doctor’s office or in a hospital, may result in contracting COVID-19 or a more severe case of COVID-19 than I might have had without the procedure.
UPDATECovid-19 Informed Consent Agreement • December 4th, 2020
Northeast Maritime Institute – College of Maritime Science (NMI) has thus far had a successful fall with welcoming students, faculty and staff back to our campuses for in-person instruction for the Fall semester of 2020. We accomplished this with the help, cooperation and participation of each and every one of us committed to the standards that we all accepted and signed through our Informed Consent Agreement. A returned, signed copy of this Updated Informed Consent Agreement is required in order to continue to participate in classes on-site and/or for continued use of on-campus housing for the remainder of the Fall 2020 semester.
ContractCovid-19 Informed Consent Agreement • July 22nd, 2020
Rebuilding COVID-19 Informed Consent Agreement (OVERNIGHT VOLUNTEER) 7.13.20 Version (Church of the Brethren) Brethren Disaster Ministries (“BDM”) is aware and constantly monitoring the COVID-19 pandemic especially as it affects and relates to how we can facilitate our rebuilding program. This will require great changes to our standard operating procedures for many months to keep all volunteers, homeowners, and local partners safe and to not add burden to the local communities still recovering.
COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • March 12th, 2021
Risk of Exposure. I, the undersigned individual, consent to an in-person consultation and/or to have my Doctor and/or his/her staff (hereinafter collectively “my Doctor”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID-19 pandemic and after. I understand in-person consultations and/or having my procedure performed at this time, despite my own efforts and those of my Doctor, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, whether performed in my Doctor’s office or in a hospital, may result in a more severe case of COVID-19 than I might have had without the procedure.
COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • May 6th, 2020
I, the undersigned patient, consent to an in-person consultation and/or to have my Doctor and/or his/her staff (hereinafter collectively “my Doctor”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID-19 pandemic and after. I understand in-person consultations and/or having my procedure performed at this time, despite my own efforts and those of my Doctor, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, whether performed in my Doctor’s office or in a hospital, may result in a more severe case of COVID-19 than I might have had without the procedure.
COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • May 19th, 2020
I, the undersigned patient, consent to an in-person consultation and/or to have David Stephens, MD and/or his/her staff (hereinafter collectively “David Stephens, MD”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID-19 pandemic and after. I understand in-person consultations and/or having my procedure performed at this time, despite my own efforts and those of David Stephens, MD, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID-19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, whether performed in David Stephens, MD office or in a hospital, may result in a more severe case of COVID-19 than I might have had without the procedure.
COVID-19 INFORMED CONSENT AGREEMENTCovid-19 Informed Consent Agreement • August 7th, 2017
I, the undersigned patient, consent to have Dr. Phillip Dauwe and his staff (hereinafter collectively “my Doctor”) perform medical procedures, whether regarded as necessary, elective or aesthetic, during the time of the COVID-19 pandemic and after. I understand having my procedure performed at this time, despite my own efforts and those of my Doctor, may increase the risk of my exposure to COVID-19. I am aware that exposure to COVID- 19 can result in severe illness, intensive therapies, extended intubation and/or ventilator support, life-altering changes to my health, and even death. I am also aware of the possibility that the procedure itself, whether performed in my Doctor’s office or in a hospital, may result in a more severe case of COVID-19 than I might have had without the procedure.
Coastal, NCCovid-19 Informed Consent Agreement • December 17th, 2021
The Covid-19 Informed Consent Agreement must be signed and returned with the Volunteer Registration form at least 2 weeks before arriving at the project location. The January 2022 updated Covid-19 Informed Consent Agreement can be found on the relevant project page or under “Forms & Guidelines”.
Dawson Springs, KYCovid-19 Informed Consent Agreement • December 16th, 2022
The Covid-19 Informed Consent Agreement must be signed and returned with the Volunteer Registration form at least 2 weeks before arriving at the project location. The most recent Covid-19 Informed Consent Agreement can be found on the relevant project page or under “Forms & Guidelines”.
