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This document includes forms related to nutritional consent waivers and refusal to follow prescribed diets in a long-term care setting. It details the risks associated with not adhering to medical
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How to fill out Victoria Special Care Center‘s Resident Nutritional Consent Waiver

01
Begin by downloading the Resident Nutritional Consent Waiver form from the Victoria Special Care Center's website.
02
Fill in the resident's full name at the top of the form.
03
Provide the date of birth of the resident in the designated area.
04
Enter the contact information of the legal guardian or responsible party if applicable.
05
Carefully read through the terms and conditions outlined in the waiver.
06
Indicate agreement or disagreement with the nutritional plans proposed by the center by checking the appropriate box.
07
If you agree, sign and date the waiver at the bottom to validate consent.
08
Submit the completed waiver form to the staff at Victoria Special Care Center either in person or via mail.

Who needs Victoria Special Care Center‘s Resident Nutritional Consent Waiver?

01
Residents of Victoria Special Care Center who are to receive specialized nutritional care.
02
Legal guardians or responsible parties who wish to authorize nutritional plans for the resident.
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The Victoria Special Care Center‘s Resident Nutritional Consent Waiver is a document that allows residents to consent to or decline specific nutritional plans, diets, or interventions as part of their care.
Residents of the Victoria Special Care Center or their legally designated representatives are required to file the Resident Nutritional Consent Waiver.
To fill out the waiver, a resident or their representative should provide personal information, indicate dietary preferences or restrictions, and sign the document to confirm understanding and consent.
The purpose of the waiver is to ensure that residents' dietary needs and preferences are respected while also protecting the facility from liability related to nutritional choices.
The waiver must include the resident's name, dietary preferences, any medical or allergy information related to nutrition, and the signature of the resident or their representative.
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