The General Consent Form For Medical Treatment is a fundamental document in Irish healthcare settings, required before administering any significant medical treatment or procedure. This document serves as both a legal record and a communication tool between healthcare providers and patients, ensuring informed consent is properly obtained and documented. It must comply with Irish healthcare regulations, including the Medical Practitioners Act 2007, the Health Act 2004, and data protection requirements under GDPR and the Data Protection Act 2018. The form is designed for use in various healthcare settings, from routine procedures to complex treatments, and includes comprehensive information about proposed treatments, risks, benefits, and alternatives. It particularly emphasizes patient understanding and voluntary agreement, incorporating specific provisions for capacity assessment and alternative decision-makers where necessary.
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1. Patient Information: Full name, date of birth, medical record number, and contact details of the patient
2. Healthcare Provider Information: Name and details of the hospital/clinic and treating healthcare professional(s)
3. Nature of Treatment: Clear description of the proposed medical treatment, procedure, or course of care
4. Purpose and Benefits: Explanation of why the treatment is necessary and its expected benefits
5. Risks and Side Effects: Description of common and serious risks, potential complications, and side effects
6. Alternative Treatments: Information about alternative treatment options and consequences of not receiving treatment
7. Declaration of Understanding: Patient's confirmation that they understand the information provided and have had the opportunity to ask questions
8. Consent Declaration: Formal statement of consent including acknowledgment of explanation received and voluntary agreement to proceed
9. Signatures: Space for patient/guardian signature, healthcare provider signature, witness signature, and date
1. Interpreter Declaration: Required when information has been provided through an interpreter, including interpreter's confirmation of accurate translation
2. Emergency Contact: Details of next of kin or emergency contact person, included for longer treatments or higher-risk procedures
3. Photography Consent: Additional consent for medical photography or recording, if required for the treatment or teaching purposes
4. Blood Transfusion: Specific consent section for blood or blood product administration, if potentially needed
5. Clinical Trial/Research: Additional consent for participation in any associated research or clinical trials
6. Student Involvement: Consent for medical student participation or observation, if relevant to teaching hospitals
7. Capacity Assessment: Required when there are concerns about the patient's capacity to consent, including healthcare provider's assessment
1. Appendix A - Detailed Procedure Information: Detailed technical information about specific procedures or treatments
2. Appendix B - Patient Information Leaflet: Supplementary written information about the treatment, risks, and aftercare
3. Appendix C - Post-Treatment Care Instructions: Detailed instructions for post-treatment care and recovery
4. Schedule 1 - List of Relevant Medications: List of medications that may be administered during treatment
5. Schedule 2 - Emergency Protocols: Specific procedures to be followed in case of emergency during treatment
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Clinical Governance
Patient Services
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