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WAUKESHA COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES CLINICAL SERVICES INFORMED CONSENT FOR TELEHEALTH SERVICES Patient Name: MAN: Date of Birth: The purpose of this document is to obtain consent
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How to fill out clinical services informed consent

01
Read the informed consent form thoroughly before filling it out.
02
Provide all the necessary personal information such as name, address, contact details, and other relevant details as requested.
03
Understand the purpose and nature of the clinical services being provided and the risks involved.
04
Ask any questions or seek clarification about the informed consent form or the clinical services if needed.
05
Consider the potential benefits and potential risks of participating in the clinical services.
06
Carefully review any statements regarding confidentiality and data protection.
07
Sign and date the informed consent form to indicate your agreement and understanding.
08
Keep a copy of the filled-out informed consent form for your records.
09
If you do not understand any part of the informed consent form, seek guidance from a healthcare professional or a legal advisor before signing.

Who needs clinical services informed consent?

01
Anyone who is going to participate in clinical services needs to fill out the clinical services informed consent form.
02
This includes patients, research participants, and individuals seeking medical or therapeutic treatments.
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Clinical services informed consent is a process through which a patient voluntarily confirms their willingness to undergo a particular medical treatment or procedure after being informed of the risks, benefits, and alternatives.
Typically, healthcare providers, including doctors and medical professionals, are required to obtain and document informed consent from patients before proceeding with clinical services.
To fill out clinical services informed consent, ensure that you provide accurate information about the patient, describe the procedure or treatment, outline potential risks and benefits, and secure the patient's signature to confirm their consent.
The purpose of clinical services informed consent is to ensure that patients are fully aware of and understand the medical procedures they are about to undergo, promoting autonomy and informed decision-making.
Information that must be reported on clinical services informed consent includes the patient's details, description of the treatment or procedure, potential risks, expected benefits, alternative options, and the patient's agreement to proceed.
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