Get the free Atlanto Axial Instability Release Form - Special Olympics Arizona

SPECIAL RELEASE FOR ATHLETES WITH ATLANTOAXIAL INSTABILITY CERTIFICATION BY PHYSICIANS We have examined the athlete named in the application, who has Down Syndrome and who has been diagnosed as having

How to fill out atlanto axial instability release

Point by point, here's how to fill out an atlanto axial instability release:

1. Begin by writing the patient's full name at the top of the form. This ensures that the document is properly identified and links it to the correct individual.
2. Provide the patient's contact information, including their address, phone number, and email (if applicable). This allows for easy communication and ensures that the patient's details are accurately recorded.
3. Include the date of when the atlanto axial instability release is being filled out. This is essential for documentation purposes and helps establish a timeline for the patient's healthcare records.
4. Specify the reason for the release. It is crucial to state that the atlanto axial instability release is being completed to authorize a specific medical procedure or treatment related to the condition.
5. Describe the risks and benefits associated with the atlanto axial instability release. This information should be provided in clear and understandable language, ensuring that the patient is fully aware of the potential outcomes and consequences.
6. Include a section for the patient's or their representative's signature. This serves as consent for the release and indicates that they have read and understood the information provided.

Who needs atlanto axial instability release?

1. Individuals diagnosed with atlanto axial instability require the release form. This condition refers to excessive movement or instability between the first two vertebrae of the neck.
2. Patients who are recommended to undergo surgical or non-surgical treatment options for atlanto axial instability will also need this release. The form ensures that they give informed consent and understand the potential risks involved.
3. As with any medical procedure, it is essential that patients fully comprehend the implications of their decision. The atlanto axial instability release allows them to make an informed choice and take an active role in their healthcare.

In summary, filling out an atlanto axial instability release involves providing the patient's information, specifying the reason for the release, describing risks and benefits, and obtaining the patient's signature. This form is needed by individuals diagnosed with atlanto axial instability who require treatment.

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What is atlanto axial instability release?

Atlanto axial instability release is a surgical procedure performed to stabilize the joint between the first and second cervical vertebrae in the spine.

Who is required to file atlanto axial instability release?

Only licensed medical professionals who perform the surgery are required to file atlanto axial instability release forms.

How to fill out atlanto axial instability release?

The form should be filled out with accurate information about the surgery, patient, and medical provider before submission.

What is the purpose of atlanto axial instability release?

The purpose of atlanto axial instability release is to reduce the risk of spinal cord injury and improve stability in the cervical spine.

What information must be reported on atlanto axial instability release?

The form should include details about the patient, the surgical procedure, any complications, and the medical provider.