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Outpatient Consent Form Guide

This document provides consent for outpatient medical care. It allows doctors and professionals at NMH to provide routine assessment, testing, and treatment for an unnamed patient on an outpatient basis. It also notes that HIV, HCV, and hepatitis B tests may be performed without consent if a health worker is exposed to the patient's blood or fluids. The patient agrees to follow medical instructions and be honest in follow-up visits. It states that medical treatment cannot be guaranteed and the patient is responsible for any risks or costs involved. The patient must provide 24 hours notice for rescheduled appointments or the appointment will be cancelled.

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60 views2 pages

Outpatient Consent Form Guide

This document provides consent for outpatient medical care. It allows doctors and professionals at NMH to provide routine assessment, testing, and treatment for an unnamed patient on an outpatient basis. It also notes that HIV, HCV, and hepatitis B tests may be performed without consent if a health worker is exposed to the patient's blood or fluids. The patient agrees to follow medical instructions and be honest in follow-up visits. It states that medical treatment cannot be guaranteed and the patient is responsible for any risks or costs involved. The patient must provide 24 hours notice for rescheduled appointments or the appointment will be cancelled.

Uploaded by

Anonymous CR8v7xb0
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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RECEIPT

------------------------------------------------------------------------------------------------------------------------

OUTPATIENT CONSENT
UHID:
Date:
Permission is hereby granted to the doctor(s) and other professionals of NMH to provide
routine medical care for

...,
including assessment, pathological testing and rendering treatment on an out-patient
basis. I have been informed and understand that HIV (human immunodeficiency
virus)/AIDS, HCV (hepatitis C virus) and HbsAg (hepatitis B virus) tests may be performed
on me without my consent if a health professional, facility employee or First Responder
sustains an exposure to my blood or other body fluid. I shall follow the medical care
related instructions of the treating doctor and be honest with regard to my feedback in
subsequent visits.
I understand that medical science doesnt guarantee any treatment/ investigation.
I am here for the treatment out of my own will & own the responsibility of all the risks
involved in my treatment and hereby relieve the Doctors and staff of NMH from legal
obligations.
I understand that I am financially responsible for all of the charges and bills associated
with my care and treatment.
I shall give 24 hrs prior notice in the event that I need to reschedule my/ my patients
appointment. In case I do not, my appointment shall be cancelled and I shall make a new
appointment.
I shall abide by the rules and regulations of Hospital.
I acknowledge and understand that I am responsible for my personal valuables. I release
NMH from any liability for loss by theft or negligence of mine or any staff of my personal
valuables.

Patient/ Patients appropriate legal representatives

Name:
Signature:

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