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Braden C. Seasons D.D.S. 151 Heidi Street, Ste 250 Kailua, Hawaii 96734 (808) 2631100 615 Pinko St., Ste 2011 Honolulu, Hawaii 96814 (808)5967788 CONSENT TO PERIODONTAL SURGERY I (name of patient)
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How to fill out consent to periodontal surgery
01
Start by carefully reading the consent form provided by your periodontist. This form will typically outline the details of the surgery, potential risks and benefits, and any alternative treatment options. It's important to have a clear understanding of what you are consenting to.
02
Fill in your personal information accurately. This usually includes your name, address, contact details, and date of birth. Make sure to use legible handwriting or type if required.
03
Provide your medical history. This section will ask about any known allergies, previous surgeries, current medications, and any existing medical conditions. It's essential to be thorough and honest in order to help your periodontist make informed decisions regarding your treatment.
04
Indicate your understanding of the procedure. This may involve checking boxes or signing off on specific aspects of the surgery. It shows that you have been adequately informed about the procedure and its potential risks.
05
Consent for anesthesia. If the surgery requires the use of anesthesia, you may need to provide separate consent for its administration. Read this section carefully and make sure you understand the type of anesthesia being used and any associated risks.
06
Signature and date. Once you have filled out the form completely, sign and date it according to the instructions provided. This signifies that you have read and understood the information presented, and you consent to the surgery.
Who needs consent to periodontal surgery?
In general, anyone undergoing periodontal surgery will need to provide consent. This applies to both adults and minors, although the consent process may differ for minors. It is important for the patient to have a clear understanding of the procedure, its potential risks and benefits, and any alternative treatment options before providing consent. Additionally, the periodontist may obtain consent from a legal guardian or parent if the patient is a minor. Consent is necessary to ensure that the patient is well-informed and actively participates in the decision-making process regarding their oral health treatment.
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