The Surgical Consent Form is a critical document required by New Zealand law and medical practice guidelines before any surgical intervention. It serves as tangible evidence that the patient has been fully informed about their procedure and has given valid consent, as required by the Health and Disability Commissioner Act 1994 and related legislation. The form must be completed prior to any non-emergency surgical procedure and includes detailed information about the proposed surgery, its risks and benefits, alternatives, and expected outcomes. It protects both healthcare providers and patients by documenting that informed consent was properly obtained and understood. The document must be written in clear, accessible language and may need to be provided in multiple languages or with interpreter services to ensure proper understanding.
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1. Patient Information: Patient's full name, date of birth, NHI number, and contact details
2. Healthcare Provider Details: Name, designation, and contact information of the primary surgeon and surgical team
3. Procedure Information: Detailed description of the proposed surgical procedure, including the surgical site and purpose of the operation
4. Risks and Benefits: Comprehensive list of common and serious risks, potential complications, and expected benefits of the procedure
5. Alternative Treatments: Description of alternative treatment options, including the option of no treatment
6. Anesthesia Consent: Information about the type of anesthesia to be used and associated risks
7. Recovery and Aftercare: Expected recovery period, post-operative care requirements, and follow-up arrangements
8. Patient Acknowledgment: Confirmation that the patient understands the information provided and has had the opportunity to ask questions
9. Consent Declaration: Formal declaration of consent, including signatures of patient/guardian and healthcare provider
1. Interpreter Declaration: Required when the patient needs an interpreter to understand the consent process
2. Clinical Photography Consent: Used when photographs or videos need to be taken for clinical documentation or teaching purposes
3. Blood Product Refusal: Required for patients who refuse blood products for religious or personal reasons
4. Research Participation: Included when the procedure is part of a research study
5. Student Involvement: Required when medical students or trainees will be involved in the procedure
6. Tissue Retention: Used when tissue samples will be retained for testing or research purposes
1. Procedure-Specific Information Sheet: Detailed information about the specific surgical procedure, including diagrams and technical details
2. Post-Operative Care Instructions: Detailed instructions for post-surgical care and recovery
3. Medication Schedule: List of medications to be taken before and after the procedure
4. Hospital Information: Practical information about the hospital stay, including what to bring and hospital policies
5. Emergency Contact Information: List of emergency contacts and when to seek urgent medical attention
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Surgery
Anesthesia
Medical Records
Legal
Quality Assurance
Patient Services
Clinical Governance
Operating Theater
Risk Management
Admissions
Relevant Roles
Surgeon
Medical Officer
Anesthesiologist
Nurse Manager
Clinical Director
Healthcare Administrator
Medical Records Officer
Risk Management Officer
Legal Compliance Officer
Patient Services Manager
Quality Assurance Manager
Clinical Governance Manager
Operating Theater Manager
Admissions Coordinator
Medical Secretary
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