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SURGERY AUTHORIZATION AND CONSENT OFFICE USE ONLY Date PIEDMONT VETERINARY CLINICPatient Name Last Name Procedure Owners initials (indicate consent to named procedure for above pet) PreSurgical Information
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How to fill out surgery authorization and consent

01
Obtain the surgery authorization and consent forms from the healthcare facility.
02
Read and understand the instructions and information provided on the forms.
03
Fill out your personal details accurately, such as your full name, date of birth, and contact information.
04
Provide information about the surgery you are authorizing, including the type of surgery, the date and time it is scheduled, and the name of the surgeon.
05
Understand and acknowledge the risks and benefits of the surgery by reading through the provided information.
06
If required, provide details of your medical history, current medications, and any known allergies.
07
Sign and date the consent form, indicating that you understand the procedure and consent to it being performed.
08
If necessary, have a witness sign the form as well.
09
Return the completed surgery authorization and consent forms to the appropriate healthcare personnel before the scheduled surgery.

Who needs surgery authorization and consent?

01
Anyone who is scheduled to undergo a surgical procedure generally needs surgery authorization and consent.
02
This applies to both adults and minors, although parental or guardian consent may be required for minors.
03
The surgery authorization and consent ensure that the individual has provided informed consent for the procedure and is aware of the associated risks.
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Surgery authorization and consent is the process of obtaining the necessary permission from a patient to perform a surgical procedure, as well as documenting that consent for legal and ethical reasons.
Surgeons, healthcare providers, or medical facilities are required to obtain and file surgery authorization and consent from the patient or their legal guardian.
Surgery authorization and consent forms can be filled out by providing the necessary information about the patient, the surgical procedure, risks and benefits, and obtaining the patient's signature.
The purpose of surgery authorization and consent is to ensure that the patient is informed about the procedure, risks, and alternatives, and has given their voluntary permission for the surgery to be performed.
Surgery authorization and consent forms typically include information about the patient's name, date of birth, medical history, the surgical procedure, risks, benefits, alternatives, and the patient's signature.
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