��������Ƶ

The IV Consent Form is a critical medical-legal document required under Indonesian healthcare regulations, particularly Law No. 36 of 2009 on Health and Minister of Health Regulation No. 290/2008. This document must be used prior to administering any intravenous procedures, including medications, fluids, or blood products. It serves multiple purposes: protecting patient rights through informed decision-making, documenting healthcare provider compliance with consent requirements, and establishing a legal record of the consent process. The form includes detailed information about the proposed IV procedure, potential risks and complications, expected benefits, alternative treatments, and post-procedure care instructions. It must be completed and signed before any IV procedure can be performed, except in emergency situations as defined by Indonesian law.

1. Header Information: Medical facility details, document title, and patient identification

2. Patient Information: Full name, date of birth, medical record number, contact details

3. Procedure Description: Detailed explanation of the IV procedure, purpose, and medication to be administered

4. Risks and Benefits: Comprehensive list of potential risks, complications, and expected benefits

5. Alternative Treatments: Description of alternative treatment options available

6. Patient Acknowledgment: Statement confirming patient understanding and voluntary consent

7. Signatures: Designated spaces for patient/guardian signature, witness, and healthcare provider