Código: WS F25

CONSENTIMIENTO Versión: 02
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HIPERBÁRICA 2021
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CONSENTIMIENTO INFORMADO TRATAMIENTO DENTRO DE LA CÁMARA DE

OXIGENACIÓN HIPERBÁRICA
INFORMED CONSENT FOR TREATMENT INSIDE THE HYPERBARIC OXYGENATION
CHAMBER

Date :_____________________

Name and surname: __________________________________________________

ID: CC___ CE___ TI___ PA___ PA___ RC___ No. ____________________

Place and Date of Birth _______________________________ Age ________

Sex M (__) F (__) Marital Status: Married ___ Unmarried ___ Single ___ Marital Status: Married ___
Unmarried ___ Single ___ Marital Status: Married ___ Unmarried ___ Unmarried ___ Unmarried ___
Single

Place of Residence: ____________________ Telephone: _____________________

Email: ________________________________ Ocupación:____________________

BENEFITS: HYPERBARIC OXYGENATION CHAMBER TREATMENT

- Accelerates the regenerative processes of the body, the soft tissue can heal in almost half the time and,
in the same way, different types of ulcers can be regenerated.

- It increases the bioavailability of antibiotics, making the infectious process heal in less time and more
effectively.

- Severe anemia

- Brain abscess.

- Air bubbles in the blood vessels (arterial gas embolism).

- Burns

- Carbon monoxide poisoning

- Oppressive injury
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CONSENTIMIENTO Versión: 02
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HIPERBÁRICA 2021
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- Sudden deafness

- Decompression sickness

- Gangrene

- Skin or bone infection resulting in tissue death

- Non-healing wounds, e.g. diabetic foot ulcers

- Radiation injury

- Skin graft or skin flaps with risk of tissue death

- Traumatic brain injury

- Sudden, painless vision loss

- Prevent muscle injuries during sports activities

- It reduces inflammation and has a vasoconstrictor effect.

- Improves sleep

- Activates collagen

POSSIBLE TRANSITORY SIDE EFFECTS

- Clogging of one or both ears during the beginning of the treatment, sometimes may result in mild
pain.

- Tinnitus-(ringing in the ear)

RECOMMENDATIONS

- Do not enter the hyperbaric chamber with any metallic objects such as watches, rings, earrings or cell
phones.

- Enter with a full stomach, because the intestine can move several times without causing discomfort,
only that you can feel the peristalsis (intestinal movement).

- Inform the doctor or the camera operator if you have flu, cold or acute sinusitis, in which case it is
best to postpone the session.

- Chewing gum, swallowing saliva, yawning several times or the Valsalba maneuver, which consists of
blowing through the nose to avoid plugging the ears.

FINAL INDICATIONS

- I was told how by means of a loudspeaker (inside the chamber) I can communicate with the doctor or
the operator to tell him how I feel.
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CONSENTIMIENTO Versión: 02
TRATAMIENTO CÁMARA Fecha:15-09-
HIPERBÁRICA 2021
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- If I suffer from claustrophobia, this therapy is not recommended. But as we have a panoramic
hyperbaric chamber with high visibility, this pathology is reduced by 90% and is always in the care of
the doctor or the operator of the Chamber expert in its management.

- I have informed _____________________________ of the treatment I am undergoing, time and place

of treatment.

- I have no doubts about the procedure, scope, medical indications and contraindications of the
procedure.

- Once the consent is signed and the hyperbaric chamber procedure is started, the patient abandons the
treatment, this does not give rise to reimbursement and / or refunds of money for the implications and
detriment it generates for William Sanchez SAS.

I, _______________________________ identified with identity card No.___________________ of

____________, acting freely, voluntarily and in full possession of my mental faculties with autonomy,
without pressure or deception, I declare that I have been informed about the treatment within the
Hyperbaric Oxygenation Chamber, better known as HYPERBARIC CHAMBER, about its multiple
benefits, possible transitory side effects, recommendations and final indications.

I have understood the explanations and I agree to undergo the Hyperbaric Chamber procedure as well
as the sessions required for the treatment indicated in my process.

In case of not understanding or not being able to sign this document, the person responsible for my
treatment who acting on my behalf can sign for me:

Is ______________________________________, ID_____________, relationship_________________

Referred by: __________________________________

_____________________ Signature of Patient Camera

------------------------------------------------- signatura of operator