Edit, Download, and Sign the Excision of Anal Skin Tag/Polyp Consent Form
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How do I fill this out?
To fill out this form, ensure you have all relevant personal details and information ready. Provide all required information accurately and thoroughly. Follow the instructions provided in each section of the form carefully.
How to fill out the Excision of Anal Skin Tag/Polyp Consent Form?
1
Print or affix your personal details.
2
Provide details of your procedure and any requirements.
3
Tick the appropriate boxes for benefits and alternatives considered.
4
Address any specific concerns and extra procedures that may become necessary.
5
Sign and date the form as required.
Who needs the Excision of Anal Skin Tag/Polyp Consent Form?
1
Patients scheduled for the excision of an anal skin tag or polyp.
2
Healthcare professionals responsible for obtaining patient consent for this procedure.
3
Carers or guardians assisting patients who require support in giving consent.
4
Hospital administrators who need to retain consent forms in patient records.
5
Individuals seeking to understand the risks, benefits, and alternatives to this procedure.
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What are the instructions for submitting this form?
Submit this form to your responsible healthcare professional at your hospital or hub. Ensure all sections are accurately completed. If you have any questions or concerns, use the contact details provided with your patient information to seek clarification and assistance.
What are the important dates for this form in 2024 and 2025?
Date of issue: 05/10/2022. Date of review: 10/2023.
What is the purpose of this form?
The purpose of this form is to provide informed consent for the excision of an anal skin tag or polyp. Patients must understand the procedure, its associated risks, benefits, and any alternatives before consenting. It ensures a shared decision-making process between the patient and healthcare professional.
Tell me about this form and its components and fields line-by-line.
- 1. First name: Provide your first name.
- 2. Last name: Provide your last name.
- 3. Date of birth: Provide your date of birth.
- 4. NHS or Hospital number: Provide your NHS or hospital number.
- 5. Responsible Health Professional: Provide the name of the responsible healthcare professional.
- 6. My requirements: Detail any specific requirements you may have.
- 7. Details of Excision of Anal Skin Tag/Polyp Procedure: Provide details of the procedure.
- 8. Indication for, and purpose of surgery/benefits: Tick the appropriate boxes for the benefits of the surgery.
- 9. Alternatives considered: Tick the appropriate boxes for the alternatives considered.
- 10. Possible early or short-term risks: Tick the appropriate boxes for early or short-term risks.
- 11. Possible late or long-term risks: Tick the appropriate boxes for late or long-term risks.
- 12. Patient specific risks: Detail any patient-specific risks.
- 13. Patient specific concerns: Detail any specific concerns or risks.
- 14. Any extra procedures which may become necessary during the procedure: Detail any extra procedures that may be necessary.
- 15. Blood transfusion: Detail if a blood transfusion may be necessary.
- 16. Other procedures: Detail any other procedures that may be necessary.
What happens if I fail to submit this form?
Failing to submit this form can result in the inability to proceed with the scheduled procedure. This may lead to the postponement of the surgery and additional consultations.
- Postponement of Surgery: The surgery may be postponed until proper consent is obtained.
- Additional Consultations: Further consultations may be required to address the lack of submitted consent.
How do I know when to use this form?
- 1. Prior to Surgery: Before the excision of an anal skin tag or polyp, this form must be filled out.
- 2. For Informed Consent: This form ensures that the patient is fully aware of the procedure, its risks, and benefits.
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What should I do if I have specific concerns?
Record any specific concerns or personal risks in the provided section of the form. Ensure these are discussed with your responsible healthcare professional.
How do I save my completed form?
After completing all necessary sections and making any edits, use the save feature on PrintFriendly. Once saved, download the updated PDF.
What information do I need to provide?
You'll need to provide personal details like your name, date of birth, hospital number, details of the procedure, and any specific concerns or requirements.
Why do I need to fill out this form?
This form is necessary to provide informed consent for the excision of an anal skin tag or polyp. It ensures you understand the procedure, its risks, and benefits.
Are there any alternatives to this procedure?
Yes, alternatives such as conservative management may be considered. Discuss these with your responsible healthcare professional during the consent process.
What are the risks mentioned in the form?
The form outlines various risks including pain, bleeding, infection, and more. Each risk is categorized based on its likelihood and potential impact.
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