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State of CaliforniaHealth and Human Services Agency California Department of Public HealthSTERILIZATION CONSENT FORM (FEDERALLY FUNDED) NOTICE: YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL

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How to fill out pm 284 sterilization consent

01

Step 1: Obtain a copy of the PM 284 sterilization consent form.

02

Step 2: Read and familiarize yourself with the instructions and information provided on the form.

03

Step 3: Fill in your personal details accurately, including your full name, date of birth, and contact information.

04

Step 4: Provide information about the doctor who will perform the sterilization procedure, including their name and contact information.

05

Step 5: Review and understand the risks, benefits, and alternatives to sterilization as outlined in the form.

06

Step 6: Sign and date the consent form, indicating your understanding and agreement to undergo sterilization.

07

Step 7: Make a copy of the completed form for your own records.

08

Step 8: Submit the original signed form to the appropriate authority or healthcare provider, as instructed.

Who needs pm 284 sterilization consent?

01

Anyone who wishes to undergo sterilization procedure, such as tubal ligation or vasectomy, usually requires the PM 284 sterilization consent form. This could include individuals seeking permanent contraception or those with medical indications for sterilization.

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What is pm 284 sterilization consent?

PM 284 sterilization consent is a form required for individuals undergoing sterilization procedures in California.

Who is required to file pm 284 sterilization consent?

Individuals who are undergoing sterilization procedures in California are required to file PM 284 sterilization consent.

How to fill out pm 284 sterilization consent?

PM 284 sterilization consent can be filled out by providing personal information, date and type of sterilization procedure, consent acknowledgment, and signature.

What is the purpose of pm 284 sterilization consent?

The purpose of PM 284 sterilization consent is to ensure that individuals undergoing sterilization procedures fully understand the implications and give informed consent.

What information must be reported on pm 284 sterilization consent?

PM 284 sterilization consent must include personal information, date and type of sterilization procedure, consent acknowledgment, and signature.

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