Order ID:89JHGSJE83839 | Style:APA/MLA/Harvard/Chicago | Pages:5-10 |
Instructions:
Martin Memorial Health Systems Stuart, Florida
SPECIAL PROCEDURE CONSENT FORM I have read, or have had read to me, and understand the following authorization for ______________________________________________________________________ ______________________________________________________________________ I authorize Dr. __________________________________ to perform the above described procedure or treatment. I have discussed my medical condition, the proposed treatment or procedure, alternatives to this treatment and the risks associated with them with my physician. I have been informed that in the performance of any invasive procedure, there is the potential for damage to my organs, nerves, and blood vessels, allergic reaction, blood clots, inadvertent puncture, laceration, infection, consequent hemorrhage, and very rarely death.
I fully understand that it may be necessary to proceed with additional procedures, or possibly surgery, to repair the injury or control and treat the complication. I specifically request my physician to proceed with whatever is deemed medically necessary and request that I be given a full explanation after the effects of sedation have subsided.
I agree to the administration of blood or blood products if they are required. (Potential risks of blood transfusions include the risk of hepatitis, AIDS, or other infections or reactions). I agree to the administration of contrast (IV dye) if required. (Potential risk of contrast reaction). I agree that any tissue or parts surgically removed may be disposed of in accordance with the hospital’s accustomed practice. I agree that my physician may permit photographs or video tapes of my procedure or treatment, employing appropriate privacy draping of my person, to record the procedure for the express purpose of medical education or to provide a record to be filed with strict confidence with my medical records. I have been informed that other practitioners may be performing important aspects of the procedure, administering anesthesia or implanting devices that are within their scope of practice.
I consent to the observation of my procedure or treatment by individuals for the purposes of medical education and to the presence of a medical representative in the operating/procedure room. I understand medical representative to mean non-medical technician of companies which have furnished operating room/procedural equipment and supplies. During this procedure I may receive MODERATE SEDATION which is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are usually required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. The patient is usually very sedated, but may still be able to hear and respond to their medical providers and remembers some
or all of their experience. Side effects and complications of moderate sedation are relatively uncommon but can occur. While it is impossible to advise you of every conceivable complication, some possible examples are; • Progression to a deeper level of sedation.
Soreness of the throat and hoarseness are very common occurrences • Aspiration (inhaling stomach contents into the lungs), asthma attacks, and pneumonia. • Nerve injuries and possible weakness or paralysis. • Allergic-type reactions leading to cardiac arrest and death. • Nodules, polyps, or other damage to the vocal cords or windpipe. • Sometimes dreams during anesthesia are confused with recall of real events.
PATIENT LABEL
MARTIN MEMORIAL HEALTH SYSTEMS STUART, FLORIDA
SPECIAL PROCEDURE CONSENT RM058 4/01, 7/07, 10/08, 1/10, 8/11, 5/13
REVISIONS MADE TO THIS CONSENT MUST BE APPROVED BY RISK MANAGEMEN
Martin Memorial Health Systems Stuart, Florida
RUBRIC |
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Excellent Quality 95-100%
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Introduction
45-41 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Literature Support 91-84 points The background and significance of the problem and a clear statement of the research purpose is provided. The search history is mentioned. |
Methodology 58-53 points Content is well-organized with headings for each slide and bulleted lists to group related material as needed. Use of font, color, graphics, effects, etc. to enhance readability and presentation content is excellent. Length requirements of 10 slides/pages or less is met. |
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Average Score 50-85% |
40-38 points More depth/detail for the background and significance is needed, or the research detail is not clear. No search history information is provided. |
83-76 points Review of relevant theoretical literature is evident, but there is little integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are included. Summary of information presented is included. Conclusion may not contain a biblical integration. |
52-49 points Content is somewhat organized, but no structure is apparent. The use of font, color, graphics, effects, etc. is occasionally detracting to the presentation content. Length requirements may not be met. |
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Poor Quality 0-45% |
37-1 points The background and/or significance are missing. No search history information is provided. |
75-1 points Review of relevant theoretical literature is evident, but there is no integration of studies into concepts related to problem. Review is partially focused and organized. Supporting and opposing research are not included in the summary of information presented. Conclusion does not contain a biblical integration. |
48-1 points There is no clear or logical organizational structure. No logical sequence is apparent. The use of font, color, graphics, effects etc. is often detracting to the presentation content. Length requirements may not be met |
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Martin Memorial Health Systems Stuart, Florida |
Martin Memorial Health Systems Stuart, Florida