Patient Informed Consent Form

Patient Informed Consent Form Template for England and Wales

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Key Requirements PROMPT example:

"I need a Patient Informed Consent Form for a private dental clinic in London that performs routine and cosmetic procedures, with specific provisions for photography consent and the option for patients to participate in our dental research program starting March 2025."

Document background

The Patient Informed Consent Form is a critical document required by law in England and Wales before conducting any significant medical procedure or treatment. It serves multiple purposes: documenting the patient's understanding and agreement to treatment, protecting healthcare providers from liability, and ensuring compliance with legal and regulatory requirements. The form must include detailed information about the proposed treatment, potential risks, expected benefits, and alternatives. It should be used whenever a medical procedure requires explicit consent, particularly for invasive procedures, surgical operations, or treatments with significant risks.

Suggested Sections

1. Patient Information: Full name, date of birth, NHS number, contact details, and relevant medical history of the patient

2. Healthcare Provider Information: Details of the healthcare facility, primary healthcare provider, and other relevant medical professionals

3. Procedure Description: Detailed explanation of the proposed treatment or procedure, including its purpose and method

4. Risks and Benefits: Comprehensive list of potential risks, complications, side effects, and expected benefits of the procedure

5. Alternative Treatments: Information about alternative treatment options and consequences of not proceeding with treatment

6. Data Protection Statement: Information about how patient data will be collected, stored, used, and shared in accordance with GDPR

7. Declaration of Consent: Patient's formal declaration of understanding and voluntary agreement to proceed with treatment

8. Signatures: Signature sections for patient, healthcare provider, and witnesses with dates

Optional Sections

1. Interpreter Declaration: Section for interpreter details and confirmation of accurate translation when patient's primary language isn't English

2. Legal Representative Authorization: Section for consent from authorized representative when patient lacks capacity to consent

3. Photography Consent: Additional consent for medical photography or video recording when procedure requires documentation

4. Clinical Trial Information: Additional information and consent requirements for procedures that are part of clinical trials

5. Student Involvement: Consent for student observation or participation in teaching hospitals

Suggested Schedules

1. Patient Information Leaflet: Detailed information about the procedure in plain language, including preparation instructions

2. Risk Statistics: Statistical data and visual representations about procedure outcomes and risks

3. Aftercare Instructions: Detailed post-procedure care guidelines, recovery information, and follow-up requirements

4. Emergency Contact Form: List of emergency contacts, relevant medical information, and action plan in case of complications

5. Medication Schedule: Details of required medications, dosages, and timing before and after the procedure

Authors

Alex Denne

Head of Growth (Open Source Law) @ ��Ƶ | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

alex.den.21@genieai.co

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