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Manzanita Wellness Clinic
Patient Informed Consent Agreement
I agree to receive acupuncture and/or message treatments and related therapies by Shoshanna Tribe, Lac.
Treatment methods may include,
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How to fill out patient consent and conditions
How to fill out patient consent and conditions
01
Obtain a patient consent form from your healthcare facility or download it from their website.
02
Read and understand the terms and conditions mentioned in the form.
03
Fill out the patient's personal information accurately, including their full name, contact details, and date of birth.
04
Provide information about the healthcare provider or institution seeking consent, such as their name, address, and contact details.
05
Clearly state the purpose of obtaining the consent and any potential risks or benefits associated with the proposed medical procedure or treatment.
06
Inform the patient about their rights regarding the use and disclosure of their health information.
07
If necessary, specify any limitations or restrictions on the consent, such as duration or specific procedures.
08
Have the patient or their authorized representative sign and date the consent form.
09
Keep a copy of the signed consent form in the patient's medical records for future reference.
10
Always ensure that the patient has understood the information provided in the consent form and has the opportunity to ask questions before signing.
Who needs patient consent and conditions?
01
Healthcare providers or institutions who are planning to perform medical procedures or provide treatments to patients generally require patient consent and conditions.
02
This includes hospitals, clinics, doctors, nurses, dentists, therapists, and other healthcare professionals.
03
Obtaining patient consent ensures that the individual is fully informed about their medical care and voluntarily agrees to proceed.
04
Patient consent and conditions are especially important when performing invasive procedures, surgeries, or treatments with potential risks involved.
05
It is necessary to respect the patient's autonomy, privacy, and right to make decisions regarding their own healthcare.
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