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CONSENT FORM PM 330 State of California Health and Human Services Agency NOTICE: Department of Health Services YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL NOT RESULT IN THE WITHDRAWAL OR WITHHOLDING

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People Also Ask about

What are the requirements for female sterilization?

The regulations prohibit sterilization of women younger than 21 years and of women with mental disabilities, require waiting periods between the time of consent and the sterilization procedure (currently, a 30-day waiting period), and require the use of a standardized consent form 22.

What is required for a woman to get her tubes tied?

You can have a tubal ligation at any time. If you are interested in getting a tubal ligation, talk with your doctor or clinic. For Medicaid or other federal programs to pay for a tubal ligation, you must be 21 years of age and have signed a consent form giving permission 30 days before the procedure.

What is pm330 consent form?

A completed PM 330 Sterilization Consent Form must accompany all claims directly related to the sterilization surgery. This requirement extends to all providers, attending physicians, surgeons, assistant surgeons, anesthesiologists and facilities.

What consent is required for sterilization?

STATEMENT OF PERSON OBTAINING CONSENT To the best of my knowledge and belief the individual to be sterilized is at least 21 years old and appears mentally competent. He/She knowingly and voluntarily requested to be sterilized and appears to understand the nature and consequences of the procedure.

What are the requirements to get your tubes tied in California?

The individual is at least 21 years old at the time written consent for sterilization is obtained. Note: Under Medi-Cal regulations, a patient must be 21 years old to give consent to a sterilization.

What is the criteria for sterilization?

The consent of the spouse is not required for sterilization. The client must bathe and wear clean and loose clothing. The client must not consume anything (even water) by mouth 4 hours prior to surgery and no solids, milk or tea 6 hours prior to surgery. On the morning of the surgery, she must empty her bowels.

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