- Review one and identify the five requirements within that consent form; explain where and how each element is noted within the actual form itself.
- Then, analyze the purpose for such consent forms from both the patient’s and organization’s viewpoints.
For your assignment this week, you will review the consent forms linked in the classroom. Then, using your textbook materials as well as the additional reading materials listed for this week, identify the five requirements within your selected consent form. Explain where and how each element is noted within the actual form itself. Then, analyze the purpose for using consent forms from both the patient’s and organization’s viewpoint.Your paper must be two to three pages in length, excluding the title and reference pages, and include at least two scholarly sources, not including the course text. Your paper and all sources must be formatted and/or cited according to APA style as outlined in the Ashford Writing Center.
BLOOD TRANSFUSION CONSENT / REFUSAL I have been fully informed of my medical condition by my physician and I have been advised that I may need blood transfusion therapy in the course of my treatment. The amount of blood I am given will be determined by my treating physicians, depending on my need. I understand that blood is administered intravenously with sterile equipment. Blood and blood components are provided to Martin Memorial Health Systems by the Central Florida Blood Bank. The blood is supplied by the community volunteer donor pool. The blood and blood products are tested and screened for infectious diseases by the Central Florida Blood Bank and by the Martin Memorial Health Systems Blood Bank. The testing is done in accordance with the American Association of Blood Banking, which is regulated by the FDA. I understand that blood transfusion therapy is a common procedure and that it is the only medical treatment which effectively and rapidly replaces excessive blood loss. The possible complications of not receiving blood or blood products range from a delay in recovery to death. Though rare, blood transfusion therapy has potential risks such as discomfort at the site of administration, fever, mild skin reactions, swelling, bruising, allergic reactions with symptoms ranging from mild to severe, even death for unknown reasons, heart failure due to circulatory overload, infectious diseases, such as acquired immunodeficiency syndrome (AIDS), viral hepatitis, both of which may be fatal, bacterial contamination with septic and toxic reaction. If blood transfusion therapy is needed for elective surgery, I may choose to give my own blood if I meet the medical criteria for autologous transfusion or I may choose to have blood donated by family or friends with my same blood type for my use. Autologous and designated donor blood must be arranged in advance and these alternative methods of transfusion carry the same risks as those stated above. CONSENT FOR BLOOD TRANSFUSION This information has been explained to my satisfaction and I have been given ample time to ask questions of my physician. I have been advised of the risks, benefits and alternatives by my physician and understand the risks and implications of blood transfusion therapy. I hereby consent to any blood transfusion deemed necessary by my physician. I authorize my physicians and Martin Memorial to disclose health information related to this treatment or procedure to any friend or family member who has accompanied me or who is waiting for me, even if I am competent or available, with the exception of the following: ___________________________________________________________. Previous reaction to blood transfusion? ( ) Yes ( ) No What was the reaction? _____________________________________________________ __________________________________________ ___________________ Patient/Authorized Surrogate or Proxy Signature Date/Time __________________________________________ __________________ Witness Signature Date/Time ================================================================ REFUSAL OF BLOOD TRANSFUSION I have been advised that my physician has recommended a blood transfusion. I request that no blood or blood products be administered to me. I understand that refusal of such treatment has risks which have been explained to me by my physician. These risks may range from a delay in recovery to death. I hereby release my physicians, Martin Memorial Health Systems, and its personnel, from any responsibility or liability for the consequences of such refusal on my part. ___________________________________________ __________________ Patient/Authorized Surrogate or Proxy Signature Date/Time ___________________________________________ __________________ Witness Signature Date/Time □ “Language Line” SM used to interpret consent form for patient