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Patient Consent Information Sheets
 

To Our Healthcare Colleagues:

These information sheets may be useful in your patient education process or in developing your own informed consent informational forms.

You are free to download and modify them.   However, this information is only for your private use with your patients. RESALE IS PROHIBITED.

Each of the information sheets is representative of another physician’s judgments of what risks, benefits and alternatives are material and important to the particular procedure.  These information sheets were developed in conjunction with the informed consent program of an out of state teaching hospital, so they may not meet the requirements for a signed informed consent in Washington State.

A Sample Informed Consent Form Template is available for your adaptation. This form was developed by Helen Johnson and modified by a team of individuals at Providence Health System in an attempt to develop an informed consent form at a basic reading level. Before using this or any other template, you should seek advice from your Risk Manager or malpractice company. For a small fee you may purchase an excellent consent manual which includes sample consent documents from the Washington State Hospital Association.

Providence Regional Medical Center Everett's (PRMCE) Consent Policy can serve as a guide as you develop consent related materials and consent related questions can be directed to the PRMCE Organizational Quality Department at 425-261-3927. The PRMCE Informed Consent Training Booklet is the basis for staff training at PRMCE and provides information about staff and physician roles in the consent process as well as the applicable state laws plus a list of procedures requiring informed consent at PRMCE.  Finally, many excellent patient education materials are available through your specialty society or MedlinePlus.

Please remember that the PRMCE Surgical and Invasive Procedure Consent form must be signed at PRMCE for invasive procedures performed at PRMCE.  The educational documents in this section are intended to supplement the physician’s educational process with the patient, but do not replace PRMCE’s need to document the patient’s procedural consent.

Signed,

Lawrence Schecter, M.D.
Chief Medical Officer

Kevin Clay, M.D.
Medical Staff President

Alphabetical listing of Consent Information Sheets
(Note: to search by keyword use Edit/Find or Crtl F)
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