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  • Nursing Iv Informed Consent: Program Studi Ilmu Keperawatan Stikes Wira Medika Ppni Bali

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    Netii Netiari Arii
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    This document is an informed consent form for an electroencephalogram (EEG) procedure for Novi Angga Putri, a 21-year-old female from Gianyar, Bali. The form provides her name, age, gender, address, and identity card number. It also states that she has given approval to undergo the EEG procedure at Surya Husada Hospital, room Rose I/VVIP, with medical record number 8080888. The nature and purpose of the procedure have been explained by the doctor, and Novi Angga Putri understands and consents to the procedure without coercion.

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    Informed Consent

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    This document is an informed consent form for an electroencephalogram (EEG) procedure for Novi Angga Putri, a 21-year-old female from Gianyar, Bali. The form provides her name, age, gender, address, and identity card number. It also states that she has given approval to undergo the EEG procedure at Surya Husada Hospital, room Rose I/VVIP, with medical record number 8080888. The nature and purpose of the procedure have been explained by the doctor, and Novi Angga Putri understands and consents to the procedure without coercion.

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    3 views2 pages

    Nursing Iv Informed Consent: Program Studi Ilmu Keperawatan Stikes Wira Medika Ppni Bali

    Uploaded by

    Netii Netiari Arii
    This document is an informed consent form for an electroencephalogram (EEG) procedure for Novi Angga Putri, a 21-year-old female from Gianyar, Bali. The form provides her name, age, gender, address, and identity card number. It also states that she has given approval to undergo the EEG procedure at Surya Husada Hospital, room Rose I/VVIP, with medical record number 8080888. The nature and purpose of the procedure have been explained by the doctor, and Novi Angga Putri understands and consents to the procedure without coercion.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
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    NURSING IV INFORMED CONSENT

    BY :

    Ni Kadek Netiari Wayan Novi Angga Putri

    (10.321.0763) (10.321.0779)

    PROGRAM STUDI ILMU KEPERAWATAN STIKES WIRA MEDIKA PPNI BALI


    2012-2013

    SURYA HUSADA HOSPITAL


    I signer here under : Name Ages / Gender Address Identity Card : Novi Angga Putri : 21 : Br. Gianyar, Desa Gianyar, Gianyar : 080989999

    Here with express in fact have given Approval / Refusal to be conducted action medical in the form of : EGG (electroencephalogram) to myself / wife / husband / father / mother / child, with : Name Ages / Gender Address Identity Card Is Taken Care in : Novi Angga Putri : 21 : Br. Gianyar, Desa Gianyar, Gianyar : 080989999 : Surya Husada Hospital

    Room Number / Class : Rose I/ VVIP Medical Record Number: 8080888 Which is target, nature of and the important of medical action above, and also rise able to generate of have enough explained by doctor and I have fully understood. That way my statement / make with conscious and without compulsion. Denpasar, April 3, 2013 Witness Signature Doctor Signature Which Make Statement Signature ( )( ) ( )

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