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1. Patient Information: Patient's personal details including name, IC number, age, gender, and contact information
2. Purpose of Test: Clear explanation of what a patch test is and why it's being performed
3. Procedure Description: Detailed description of how the patch test will be conducted, including duration and follow-up visits
4. Risks and Side Effects: Comprehensive list of potential risks, side effects, and discomfort associated with the patch test
5. Patient Instructions: Clear instructions for patient behavior during the test period, including activities to avoid
6. Declaration of Consent: Formal statement of patient's understanding and agreement to undergo the procedure
7. Healthcare Provider Details: Information about the healthcare provider, facility, and supervising medical professional
1. Interpreter Declaration: Section for interpreter details and confirmation when the patient requires language assistance
2. Previous Allergies: Section for documenting known allergies when patient has relevant medical history
3. Photography Consent: Optional consent for taking photographs of test results for medical documentation
4. Guardian Consent: Additional section when the patient is a minor or unable to provide consent themselves
1. Appendix A: Test Substances: List of substances to be used in the patch test
2. Appendix B: Emergency Contact Information: Emergency contact details and procedures in case of adverse reactions
3. Appendix C: Post-Test Care Instructions: Detailed instructions for skin care and monitoring after the test
Healthcare
Medical Services
Dermatology
Allergology
Cosmetic Medicine
Clinical Research
Medical Testing
Legal
Compliance
Medical Administration
Clinical Operations
Quality Assurance
Patient Safety
Medical Records
Clinical Research
Nursing
Risk Management
Dermatologist
Allergist
Medical Officer
Clinic Manager
Healthcare Administrator
Legal Compliance Officer
Medical Director
Nurse Practitioner
Clinical Research Coordinator
Quality Assurance Manager
Patient Safety Officer
Medical Records Manager
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