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Tel:514595ENDO 5147882311 Fax: 5147882313 www.endovisionclinic.com CONSENT FORM FOR COLONOSCOPY & ESOPHAGOGASTROSCOPY TO THE PATIENT: PLEASE READ CAREFULLY AND COMPLETE THIS CONSENT FORM Section A.
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How to Fill Out the Consent Form - Endovision:

01
Begin by reading the consent form carefully to understand the purpose and implications of the procedure or treatment being authorized.
02
Ensure that all fields requiring personal information are properly filled out, including your full name, date of birth, contact details, and address.
03
Provide accurate and relevant medical history information, including any pre-existing conditions, allergies, or medications you are currently taking.
04
If there are specific risks or potential complications associated with the procedure, make sure to carefully review and understand them, and indicate your acknowledgement and acceptance of these risks on the form.
05
If there are any questions or concerns regarding the consent form, seek clarification from the healthcare provider or the person administering the procedure before signing.
06
After reviewing and completing the form, sign and date it to indicate your informed consent and agreement to proceed with the procedure or treatment.
07
Keep a copy of the consent form for your records, and ensure that a copy is also provided to the healthcare provider or institution.

Who Needs the Consent Form - Endovision?

01
Patients undergoing any endoscopic procedure or treatment that requires consent, such as endoscopy, colonoscopy, bronchoscopy, or cystoscopy.
02
Individuals who are receiving sedation or anesthesia during the endovision procedure.
03
Patients participating in any research studies or clinical trials involving endovision techniques.
04
Minors who are undergoing endovision procedures, where consent is required from their parent or legal guardian.
05
Any individual who wants to have a clear understanding of the procedure they are about to undergo and wants to give their informed consent before it is performed.
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The consent form - endovision is a document that authorizes the endoscopic procedure to be performed.
The patient undergoing the endoscopic procedure and the healthcare provider performing the procedure are required to file the consent form.
The consent form - endovision can be filled out by providing personal information, signing the form to authorize the procedure, and acknowledging any risks involved.
The purpose of the consent form - endovision is to ensure that the patient understands and agrees to the endoscopic procedure being performed.
The consent form - endovision should include details about the procedure, any potential risks or complications, and the patient's acknowledgment of consent.
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