Patient Agreement to Investigation or TreatmentPatient Agreement to Investigation or Treatment • February 14th, 2022
Common problems after treatment (up to 1 in 20 procedures): Temporary pain, redness, soreness, conjunctival haemorrhage (bloodshot eye), visual disturbance such as small specks in vision (floaters).
Patient/Parental Agreement to Investigation or Treatment for procedures where consciousness is not impairedPatient Agreement to Investigation or Treatment • March 6th, 2019
Is the patient: Male Female Do they have any special requirements:(e.g. other language/other communication method) …………………………………………………………………………………… Consultant/Responsible Health Professional:……………………………………………………………………………………
Consent Form 1 – Patient Agreement to investigation or treatmentPatient Agreement to Investigation or Treatment • November 8th, 2020
Name of proposed procedure or course of treatment (include brief explanation if medical term not clear) …………..………Surgical operation to remove pregnancy remains from within the uterus (womb)…………….
Patient Agreement to Investigation or TreatmentPatient Agreement to Investigation or Treatment • October 14th, 2022
Family name Hakami First name Abdullah Date of birth 19.08.1995 Age 26 years Gender M File number 1076910 Responsible health professional Dr. Hamad Albagieh Job title Consultant- Oral Medicine Special requirements None
ContractPatient Agreement to Investigation or Treatment • March 7th, 2017
NHS N° (if known): ST HUGH’STOTAL HIP REPLACEMENTPatient Agreement to Investigation or Treatment (Consent form 1) Case Note N°: Patient Surname / Family Name: Patient First Names: Address: Responsible Health Professional: Job Title: Date of Birth: Ward: Special requirements / Sensory impairments of the patient (e.g. Other Language / other communication method): GP: Male Female
Patient agreement to Investigation or TreatmentPatient Agreement to Investigation or Treatment • October 20th, 2021
