User Guide: Surgery Consent Form
This user guide will help you understand how to properly fill out the Surgery Consent Form.
Overview
The Surgery Consent Form is a digital document that allows patients to provide informed consent for surgical procedures. The form collects patient information, details about the surgery, and acknowledges understanding of risks and alternatives.
How to Use the Form
1. Accessing the Form
- Open the form in a web browser on your computer, tablet, or smartphone
- Ensure you have JavaScript enabled for full functionality
2. Filling Out Patient Information
- Patient Full Name: Enter your legal first and last name
- Date of Birth: Select your birth date using the date picker or enter in MM/DD/YYYY format
- Address: Enter your complete residential address
- Phone Number: Provide a contact number where you can be reached
3. Surgical Procedure Information
- Proposed Procedure: Enter the exact name of the surgical procedure
- Surgeon's Name: Provide the full name of the surgeon performing the procedure
- Date of Proposed Surgery: Select the scheduled surgery date
- Surgery Location: Enter the name and address of the medical facility
- Type of Anesthesia: Specify the anesthesia method to be used (general, local, etc.)
4. Risks and Complications Section
- Read the provided information carefully
- The text area allows your physician to list specific risks associated with your procedure
- If you have questions about any listed risks, ask your physician before signing
5. Alternatives Section
- Your physician will document alternative treatment options in this section
- Review these alternatives and ensure you understand why the proposed surgery is recommended
6. Consent Section
- Read all bullet points carefully
- Ensure you understand each point before proceeding to sign
- Do not sign if you have unanswered questions or concerns
7. Signature Area
- Patient Signature: Physically sign your name on the printed form (digital signature not enabled in this version)
- Date: Enter the current date when signing
- Witness Signature: A witness must sign after observing your signature
- Witness Printed Name: The witness should print their name clearly
- Physician Signature: Your physician will sign the form
- Physician Printed Name: Your physician will print their name
8. Printing the Form
- Click the "Print This Form" button to generate a physical copy
- Review the printed document for accuracy before finalizing signatures
- Ensure all required parties sign the printed document
Important Notes
- Complete all required fields before printing
- Do not sign the form until you have discussed all aspects with your physician
- Keep a copy of the signed form for your records
- Ask questions about anything you don't understand before signing
Technical Requirements
- Modern web browser (Chrome, Firefox, Safari, Edge)
- JavaScript enabled for print functionality
- Printer connected for generating physical copies
Troubleshooting
- If the form doesn't display properly, try refreshing the page
- Ensure your browser is updated to the latest version
- If printing issues occur, check your printer connection and settings
Privacy and Security
- The form does not automatically save or transmit data
- All information remains local to your device until printed
- Dispose of any misprinted forms securely to protect personal information
If you encounter any difficulties using this form, please contact your healthcare provider's office for assistance.