Si se han proporcionado los servicios de un intérprete para asistir a la persona que será esterilizada: He traducido la información y los consejos que verbalmente se le han presentado a la persona que será esterilizada/o por el individuo que ha obtenido este consentimiento.

I consent to the use of sedation, as may be necessary and advisable to achieve moderate sedation. I understand that moderate sedation may involve some risk even though administered in a careful manner.

In some practices, you may have clients that are Spanish speaking and need Spanish versions of your consent documents.To easily access and send Spanish versions of your consent documents, you'll want to create them in your account. To do this: Locate the Spanish form you'd like to use from the list below; Select and copy the full text of the ...

Autorización de vacunas: Mi firma en este formulario indica que he solicitado que un representante del Departamento de Salud de Indiana me administre a mí o a mi dependiente …

Consent, Refusal, Instruction and Treatment forms for Spanish-speaking patients. When your patient's primary language is Spanish, it impedes your ability to get accurate information with English forms. Use these Spanish forms from Cigna Healthcare SM for …

El (Acta de 1996 del Seguro de Salud de Portabilidad y Responsabilidad) HIPAA ley permite el uso de la información para las operaciones de tratamiento, pago o atención médica. Al firmar este formulario, usted da su consentimiento a nuestro uso y divulgación de su información de salud protegida y su uso potencial en el anonimato en una publicación.

PATIENT CONSENTS: (Spanish) Please initial each consent section ____ Consent to Procedure: The undersigned patient/ responsible party consents to the imaging procedure(s) listed above ordered by my physician.

Formulario de Consentimiento General del Paciente para la Atención Consentimiento general para el cuidado: Yo, el abajo firmante, para mí o un niño menor de edad u otra persona para quien tengo autoridad para firmar, por la

I consent to photographs, digital or audio recordings, and/or images of me being recorded for patient care, security purposes and/or the practice’s/clinic’s health care operations purposes (e.g., quality improvement activities).

Patient Consent Forms in English and Spanish are located below. Please select the form you need, print it, mark and sign as directed, and when completed, return it to the office. Please let us know if you need assistance.