Get the free OUTPATIENT GENERAL CONSENT FORM

OUTPATIENT GENERAL CONSENT From This consent applies to Indiana University Health Southern Indiana Physicians, its agents, associates, as well as providers. In each paragraph IU Health Southern Indiana

How to fill out outpatient general consent form

How to fill out outpatient general consent form

1. To fill out the outpatient general consent form, follow these steps:
2. Start by entering the current date in the designated field.
3. Provide your full legal name, including any middle names or initials.
4. Include your date of birth and gender.
5. Enter your complete address, including street, city, state/province, and zip/postal code.
6. Include your contact information, such as phone number and email address.
7. Indicate your emergency contact person's name and phone number.
8. If applicable, provide your insurance information, including the policy number and group/employer name.
9. Read through the consent form carefully, making sure to understand all the terms and conditions.
10. Sign and date the form in the designated fields.
11. If you have any questions or concerns, seek clarification from the healthcare provider before submitting the form.

Who needs outpatient general consent form?

1. The outpatient general consent form is required for anyone receiving outpatient medical services.
2. This includes individuals who are seeking medical care, treatment, or procedures on an outpatient basis.
3. It is necessary for both new and returning patients, regardless of age or specific medical condition.
4. The form ensures that the patient understands and agrees to the general policies and procedures in place at the outpatient facility.
5. It also serves as a legal document outlining the patient's consent for the healthcare provider to perform necessary medical interventions.
6. Without a signed consent form, the healthcare facility may be unable to provide the requested outpatient services.

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