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817 Lawn Avenue, Belleville, PA 18960 215.453.3050 Consent For Upper Endoscopy Patient Date Introduction: Your Doctor, has scheduled you for an examination of the esophagus, stomach and duodenum using
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How to fill out consent of upper endoscopy
How to fill out consent for upper endoscopy:
01
Read the consent form thoroughly to understand the procedure, risks, benefits, and alternatives associated with upper endoscopy.
02
Fill in your personal information such as name, date of birth, and contact details accurately.
03
Carefully review the information regarding anesthesia options and indication for the upper endoscopy.
04
If you have any allergies or medical conditions, ensure to mention them on the form.
05
Sign and date the consent form to acknowledge that you understand the procedure and give your permission for it to be performed.
Who needs consent for upper endoscopy:
01
Individuals who are scheduled to undergo upper endoscopy as part of their medical evaluation or treatment.
02
Patients who are above the legal age of consent and have the mental capacity to understand the procedure and its potential risks.
03
In some cases, minors may require consent from their legal guardians or parents before undergoing an upper endoscopy. The specific requirements may vary based on local regulations and institutional policies.
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