PATIENT AGREEMENT/INFORMED CONSENT FOR FEMALE PATIENTSPatient Agreement/Informed Consent • May 16th, 2024
Psychology Clinic- Patient Agreement & Informed ConsentPatient Agreement & Informed Consent • September 9th, 2019
Welcome to the ISU Psychology Clinic. This document/agreement contains important information about: 1) our professional services and special conditions related to being a training clinic, 2) summary information about privacy and confidentiality, and 3) our clinic business practices. Although a bit long and complex, it is important that you read it carefully and ask any questions you might have today, or before your next session. We will give you a copy to take home. When you sign this document, it will represent an agreement between us. However, you may revoke this agreement in writing at any time. That revocation will be binding unless a) the clinic has already taken action in reliance on it, b) the clinic has legal obligations imposed on it by a court of jurisdiction or your health insurer in order to process claims made under your policy, or c) if you have not satisfied financial obligations you have incurred.
PATIENT AGREEMENT/INFORMED CONSENT FOR FEMALE PATIENTSPatient Agreement/Informed Consent • January 31st, 2014
PATIENT AGREEMENT/INFORMED CONSENTPatient Agreement/Informed Consent • September 25th, 2019
FOR FEMALE PATIENTS TAKING ARTHROTEC (Misoprostol/Diclofenac) Patients & their parents' or guardians' (where applicable*) are to complete this form.
PATIENT AGREEMENT/INFORMED CONSENTPatient Agreement/Informed Consent • June 18th, 2014
Please read each item below and initial in the space provided to show that you understand each item. *These must also be initialed by the parent or guardian of a minor patient (under age 18). Do not sign this consent and do not take SORIATANE (aka Neotigason; generic name, Acitretin) if there is anything that you do not understand.
PATIENT AGREEMENT/INFORMED CONSENTPatient Agreement/Informed Consent • September 25th, 2019
Cytotec (Misoprostol) should not be used in women of childbearing potential unless they are at high risk of complications from NSAID-induced gastric ulcers. Upon medical evaluation by a licensed prescriber, Cytotec (Misoprostol) may be prescribed to a female patient of childbearing potential if:
