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PATIENT INFORMATION and CONSENT FORM **The information requested is very important. In order for your child to receive dental care provided by the Jordan Valley staff, you will need to read this form
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To fill out an informed consent form, follow these steps:
02
Read the entire form carefully, understanding the purpose and risks involved.
03
Ask any questions you may have to the healthcare provider or research team.
04
Ensure you understand all the information provided before proceeding.
05
Provide accurate personal information such as name, age, and contact details.
06
Carefully review all sections of the form and make sure to fill in all the required fields.
07
If necessary, seek legal or medical advice before signing the consent form.
08
If you agree with the terms and conditions, sign and date the form.
09
Keep a copy of the signed consent form for your records.
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Don't hesitate to ask for a copy of the form for yourself.

Who needs informed consent and patient?

01
Informed consent is required for all individuals who are capable of giving consent, including:
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- Patients undergoing medical procedures or treatments
03
- Participants in clinical trials or research studies
04
- Donors of organs, tissues, or eggs for transplantation
05
- Patients participating in experimental or investigational therapies
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- Minors, in some cases with the consent of a legal guardian
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- Individuals participating in mental health or counseling services
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- Any person being offered a medical intervention or procedure that carries potential risks.
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Informed consent is the process by which a patient voluntarily agrees to a medical procedure or treatment after being fully informed of its risks, benefits, and alternatives. It ensures that patients understand and authorize the intervention before it takes place.
Healthcare providers, including doctors and hospitals, are required to obtain and document informed consent from patients before proceeding with treatments or procedures.
To fill out an informed consent form, the healthcare provider should present the patient with the form, explain the procedure or treatment in clear language, discuss potential risks and benefits, address any questions from the patient, and obtain the patient's signature to indicate understanding and agreement.
The purpose of informed consent is to protect patient autonomy, ensure that patients make knowledgeable decisions about their healthcare, and foster trust between patients and healthcare providers.
The informed consent form must include details about the procedure or treatment, potential risks and side effects, expected outcomes, alternatives to the procedure, and the opportunity for the patient to ask questions.
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