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07/2017Informed Consent for Orb era Intragastric Balloon Administration Patient Name DOB MAN Please read this form carefully and ask about anything you may not understand. I request that my physician
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01
First, obtain the Orbera informed consent form 042317.
02
Read through the form carefully to understand the information and requirements.
03
Fill out the patient's personal information accurately, including their name, date of birth, and contact details.
04
Ensure that the patient's medical history and any relevant conditions or allergies are documented correctly.
05
Review the risks and benefits section, and make sure the patient is aware of the potential complications and outcomes.
06
If the patient has any questions or concerns, address them before proceeding.
07
Both the patient and the healthcare provider should sign and date the form to indicate their consent.
08
Make a copy of the completed form for the patient's records.
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Who needs orbera informed consent 042317?

01
Anyone who is considering undergoing orbera treatment needs to complete the Orbera informed consent form.
02
This includes individuals who have been advised by their healthcare provider to undergo the procedure as part of their weight loss efforts.
03
The form ensures that the patient understands the risks and benefits associated with Orbera and provides consent for the treatment.
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Orbera informed consent 042317 is a form that patients need to sign to indicate their understanding and agreement to undergo Orbera weight loss treatment.
Patients who are considering undergoing the Orbera weight loss treatment are required to file the Orbera informed consent form.
To fill out the Orbera informed consent form, patients must carefully read the information provided, sign the form to indicate their agreement, and date it accordingly.
The purpose of Orbera informed consent 042317 is to ensure that patients understand the risks and benefits associated with the Orbera weight loss treatment and give their informed consent to proceed with the procedure.
On the Orbera informed consent form, patients must report their understanding of the procedure, any potential risks, the expected benefits, and their agreement to comply with post-procedure guidelines.
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