east zone medico legal services pvt.ltd

1. East zone medicolegal servicespvt.ltd
What things should be checked in case of a
dispute regarding consent?
 Medical consent
 High-risk medical consent
 Surgical consent
 High-risk surgical consent
 Implied consent
 Informed consent: Whether all components are
present or not
Overwriting in consent
ÂÂ Role of witness
ÂÂ Who has given consent: Patient/Spouse/Guardian
if minor
ÂÂ Signature on each page
ÂÂ Extended consent
ÂÂ Negative consent
What are the model contents of a consent form?
The contents of a consent form include the following:
ÂÂ Name of the patient/Age/Sex/Bed number/Hospital
number
ÂÂ Day and time
ÂÂ Consent given by Patient/Spouse/Parents, if minor
ÂÂ Witnesses present.
ÂÂ Following issues have been addressed: Diagnosis,
proposed treatment with its risks and benefits,
alternative treatments with its risk and benefits.
ÂÂ I have been told specific risks and benefits as under:
ÂÂ I have been communicated in my own language.
ÂÂ I agree with the explained plan and give my
consent.
ÂÂ All my queries have been answered.
ÂÂ I am giving my extended consent for the following
…………
ÂÂ If I develop any complications I hereby authorize
………. to take all decisions on my behalf.
ÂÂ My doctors has supported all his plan with
scientific literature
ÂÂ All the data in the form has been filled up in my
presence
ÂÂ I have not hidden any information from my
doctors.
What is a model medical (nonsurgical) consent
form?
I ……………………S/o, D/o, W/o …………………………..
hereby give my consent for the following:
I will be treated by a team of ………………and

2. East zone medicolegal servicespvt.ltd
………………….. along with a team of doctors assigned
by the hospital including a critical care team from the
hospital and I have been explained in my own language
about the following by the treating doctors:
1. Plan about the disease, investigations, treatment
and discharge plan.
2. I have been explained about the cost incurred at
each level.
3. I have been explained about the credit and/or
Mediclaim bills in which many ancillary items
may not be reimbursed (like cost of consumables),
for which I may be billed directly.
4. I have been explained that my doctors will not
be responsible if any faulty information has been
provided by me, while filling Mediclaim or credit
bill case forms.
5. I have been explained that any test done for illness
for which I am not admitted may not be covered
by Mediclaim or credit bill establishment.
6. Kindly communicate about my illness to me or
……….……….……….…......……. in my absence.
7. In case I become serious, I assign Mr./Mrs
.……….……….………...........………. to give
consent on my behalf.
8. In case I am not satisfied by any service, I will
inform/complain to my primary treating doctor
on the same day.
9. I understand that my primary doctors are
honorary doctors/ paid hospital doctors.
10. During emergency and in the odd hours a team
of hospital doctors will look after me including a
team of ICCU or critical care consultants on call. 11. It may be possible that in emergency
my primary
doctor/s may not be available in the hospital
premises.
12. That all decisions regarding my treatment are
taken or informed to my primary doctors but
emergency decisions may be taken by the hospital
provided doctors and/or consultants.
13. That the fee charged by the hospital doctors or
critical care doctors will be separate.
14. That my primary doctors may call other specialists
and other consultants for more opinions, cross
opinions or management help depending upon
the need.
15. That all the investigative facilities may not be
available in the hospital and for some, the patient
after informing the relatives, may need to be
shifted to some other diagnosis facility.

3. East zone medicolegal servicespvt.ltd
16. That normally my primary doctors will charge
for two visits but in serious cases, ICU cases,
diabetics on sugar monitoring, uncontrolled
hypertension, etc. the charges may be for one
extra emergency visit.
17. You can contact on phone your primary doctors
in case of any emergency situation. For regular
query you can contact room no ………. from 9 am
to 4 pm.
■ ■ ■ ■
Witness 1:………………
Witness 2:……………….