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  • Consent Ingles

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    SUCURSAL ALTAMIRANO
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    This informed consent form is for a planned procedure by Dr. Paulina Román Zavala. It lists the expected benefits of the procedure such as clinical improvement and reduced risks of various issues. It also notes risks such as bleeding, infection, and even death. The patient authorizes the medical team to treat any contingencies or emergencies from the procedure. The form requires signatures from the patient, physician, and witnesses.

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    consent ingles

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    This informed consent form is for a planned procedure by Dr. Paulina Román Zavala. It lists the expected benefits of the procedure such as clinical improvement and reduced risks of various issues. It also notes risks such as bleeding, infection, and even death. The patient authorizes the medical team to treat any contingencies or emergencies from the procedure. The form requires signatures from the patient, physician, and witnesses.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    4 views1 page

    Consent Ingles

    Uploaded by

    SUCURSAL ALTAMIRANO
    This informed consent form is for a planned procedure by Dr. Paulina Román Zavala. It lists the expected benefits of the procedure such as clinical improvement and reduced risks of various issues. It also notes risks such as bleeding, infection, and even death. The patient authorizes the medical team to treat any contingencies or emergencies from the procedure. The form requires signatures from the patient, physician, and witnesses.

    Copyright:

    © All Rights Reserved
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    Flag for inappropriate content
    of 1

    Dra.

    Paulina Román Zavala


    UROLOGÍA DE EXCELENCIA

    CÉDULA PROFESIONAL: 13650079

    Informed Consent

    NAME; DATE:

    AGE: SEX: .

    PLANNED PROCEDURE:

    RISKS AND EXPECTED BENEFITS OF THE AUTHORIZED MEDICAL ACT

    The expected benefits of the intervention are to achieve clinical improvement of local symptoms, reduce the risk
    of urinary incontinence, increase hydration in the vaginal mucosa, reduce the risk and symptoms of vaginal
    atrophy, improve voiding dynamics, reduce the risk of lower urinary tract infections.

    There is a risk of presenting an anaphylactic reaction to any administered substance, risk of bleeding, hematoma
    formation, surgical site infection, shock and death.

    I authorize health
    personnel to attend to contingencies and emergencies arising from the authorized act.

    PATIENT'S SIGNATURE FULL NAME AND SIGNATURE OF


    WITNESSES.

    PHYSICIAN'S NAME FULL NAME AND SIGNATURE OF


    AND SIGNATURE WITNESSES.

    paurology.ro@gmail.com
    Citas WH/App: 6122207346 Aquiles Serdán 3175, Pueblo Nuevo, 23060 La Paz,
    Urgencia: (66) 77519967 B.C.S

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