Get the free Tympanostamies Consent Form - Eastern Shore ENT & Allergy
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James R. Gaul, M.D. Michael J. Keller, M.D. Daniel J. Kelley, M.D. Patients Name: Soc. Security No. Date of Surgery/Procedure: I hereby request DRS. Tympanostamies with or without tubes To perform
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How to fill out tympanostamies consent form
How to fill out a tympanostomy consent form:
01
Begin by reading the form carefully to understand the purpose and implications of the procedure.
02
Provide personal information such as name, date of birth, and contact details accurately.
03
If applicable, state the name of the patient's legal guardian or representative.
04
Indicate any known allergies or medical conditions that could affect the procedure.
05
Understand the risks and potential complications involved in the tympanostomy procedure.
06
Sign and date the form, indicating your consent for the procedure to be performed.
07
If necessary, have a witness sign and date the form as well.
Who needs a tympanostomy consent form:
01
Patients who are scheduled to undergo a tympanostomy procedure.
02
Parents or legal guardians of minor patients requiring a tympanostomy.
03
Individuals who have been deemed unable to provide informed consent and have a designated representative.
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