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CONSENT FOR CARE AND TREATMENT AUTHORIZATION Fairmount Pediatrics and Adolescent Medicine 2000 Hamilton Street, Suite 109, Philadelphia, PA 19130 Phone: (215) 7741166 Fax: (215) 2798383 http://fairmountpediatrics.com

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How to fill out consent for care and

How to fill out consent for care and:

01

Start by carefully reading through the consent form. Make sure you understand all the terms and conditions mentioned.

02

Fill in your personal information such as your name, date of birth, and contact details. This is important for identification purposes.

03

Provide information about your primary healthcare provider or physician, including their name and contact information. This is necessary for communication and coordination of care.

04

Clearly specify the treatments or procedures for which you are granting consent. If there are any risks or potential side effects associated with these treatments, make sure they are properly explained and understood.

05

If applicable, include information about any allergies or medical conditions you have. This is crucial for healthcare providers to ensure your safety and well-being during treatment.

06

Sign and date the consent form. This indicates that you are giving your informed consent willingly and understand the implications of the care or treatment being provided.

Who needs consent for care and:

01

Patients: In the healthcare context, patients are generally required to provide consent for any care or treatment they receive. This applies to both routine procedures and more invasive treatments.

02

Parents or guardians: In the case of minors or individuals who are unable to provide informed consent due to mental or physical disabilities, their parents or legal guardians typically act as their advocates and provide consent on their behalf.

03

Legal representatives: In situations where a person is incapacitated or unable to provide consent, a legal representative, such as a power of attorney or court-appointed guardian, may step in to make healthcare decisions and provide consent for care and treatment.

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