The Skin Tag Removal Consent Form is a critical document used in Nigerian healthcare settings prior to performing skin tag removal procedures. This document is essential for maintaining compliance with the Medical and Dental Practitioners Act and the National Health Act 2014, while ensuring proper documentation of informed consent. It should be used whenever a healthcare provider plans to perform a skin tag removal procedure, regardless of the method used (surgical excision, cryotherapy, or electrocautery). The form includes detailed information about the procedure, risks, benefits, alternatives, and post-procedure care, while documenting the patient's understanding and voluntary consent. It serves both as a legal protection mechanism for healthcare providers and as an educational tool for patients, ensuring all parties are fully informed about the procedure and its implications.
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1. Patient Information: Patient's full name, date of birth, contact details, and medical record number
2. Procedure Description: Detailed explanation of the skin tag removal procedure in clear, non-technical language
3. Risks and Complications: List of potential risks, side effects, and complications associated with the procedure
4. Benefits: Expected benefits and outcomes of the skin tag removal procedure
5. Alternative Treatments: Description of alternative treatment options available to the patient
6. Patient Acknowledgment: Statement confirming that the patient understands the procedure, risks, and has had the opportunity to ask questions
7. Consent Declaration: Formal declaration of consent to undergo the procedure
8. Healthcare Provider Declaration: Statement from the healthcare provider confirming that they have explained the procedure and answered all questions
9. Signatures: Spaces for signatures of patient, healthcare provider, and witness, with dates
1. Interpreter Declaration: Section to be included when the patient requires an interpreter to understand the consent form
2. Guardian Consent: Additional section required when the patient is a minor or lacks capacity to provide consent
3. Photography Consent: Optional section for consent to photograph the area before and after treatment for medical records
4. Insurance Information: Section for recording insurance details if the procedure is being covered by health insurance
5. Post-Procedure Care Instructions: Detailed instructions for after-care, though this is sometimes provided as a separate document
1. Pre-Procedure Instructions: Detailed checklist of preparations required before the procedure
2. Post-Procedure Care Guide: Comprehensive guide for wound care and recovery after the procedure
3. Risk Assessment Form: Detailed medical history and risk assessment questionnaire
4. Photo Documentation: If applicable, photos of the skin tag(s) to be removed with anatomical location markers
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