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Princess Margaret Hospital for Children
Human Research Ethics Committee
Patient Consent Form for Case Reportage of person described in article
Subject of article
insert Parent/Guardians full name
give
my
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How to fill out patient consent form for
01
Start by obtaining a copy of the patient consent form.
02
Read the form thoroughly to understand its purpose and the information required.
03
Use a black or blue pen to complete the form.
04
Begin by filling out your personal information, such as your name, date of birth, and contact details.
05
Provide details about your medical history, including any pre-existing conditions or allergies.
06
Indicate any medications you are currently taking or have taken recently.
07
Specify the purpose of the form and the actions you are consenting to, whether it's treatment, medical procedures, or research participation.
08
If required, provide information about the person authorized to make decisions on your behalf, such as a legal guardian or healthcare proxy.
09
Sign and date the form at the designated areas, indicating your agreement and understanding.
10
Review the completed form to ensure all fields are accurately filled out.
11
Make a copy of the signed form for your records, if needed.
12
Submit the completed patient consent form to the appropriate party or healthcare provider.
Who needs patient consent form for?
01
Patient consent forms are typically required for individuals seeking medical treatment or participating in clinical trials.
02
Other situations where patient consent forms may be necessary include:
03
- Medical research studies where participants' information and data will be collected and analyzed.
04
- Surgical procedures or invasive treatments that carry certain risks and require explicit consent.
05
- Participation in experimental therapies or treatments.
06
- Release of medical information to third parties, such as insurance companies or legal representatives.
07
- Mental health treatment or counseling sessions where the patient's consent is required for confidentiality.
08
- Donations of organs, tissues, or body parts.
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