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你的旅程
1. 试管婴儿前期检查
如何在体外受精前准备
Pregnable 培孕宝
2. 体外受精过程
试管婴儿流程指南
试管部门医生&实验室
试管婴儿部门费用
3. 前往泰国
在線預訂
BNH服务
BOOCS健康疗法
儿科
保育室
網上商店
泰国 BNH 医院
联系我们
Consent Form for Againt Medical Advice (Eng)
Consent Form for Against Medical Advice
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I am a
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Patient
Legal representative
Name - Surename
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Age
*
Identification Number / Passport Number
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Name - Surename (Patient)
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Age (Patient)
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State the reason the patient is not able to give consent personally (or to self sign on this form)
*
Under legal age of self-consent —patient with age not yet completing 20 year
Incompetent person/ qausi-incompetent person
Person with insanity in the mind
Other
Other
Relationship to the patient
*
Name - Surename (Legal representative)
*
Please upload your Identification card / Passport (Legal representative)
*
Drop a file here or click to upload
Choose File
Maximum upload size: 268.44MB
I hereby acknowledge and confirm that I have been fully and entirely informed by the physician(s) , nurse(s) and medical staff of BNH Hospital of the necessity of the medical investigations, treatments and surgeries; and, after my thorough and careful consideration,
I have the intention to:
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Refuse medication therapy
Refuse anesthesia and/or surgery
Refuse procedure
Refuse admission to the hospital for treatment or continuation of treatment at the hospital
Refuse to attempt Cardiopulmonary Resuscitation (Cardiopulmonary ResuscitatiOn an emergency procedure that combines chest compresSiOns often with artificial ventilation in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is in cardiac arrest)
Refuse investigation
I have received information from the physician about the symptoms of the disease andtor injury that may jeopardize my health or life. The physician has explained to me the risks and benefits of the recommended treatment. I am choosing to leave BNH Hospital against medical advice and release BNH from any responsibility resulting from this decision.
I hereby refuse to receive the treatment detailed above
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Clear
I hereby refuse to receive the treatment detailed above
*
Clear
Submit
你的旅程
1. 试管婴儿前期检查
如何在体外受精前准备
Pregnable 培孕宝
2. 体外受精过程
试管婴儿流程指南
试管部门医生&实验室
试管婴儿部门费用
3. 前往泰国
在線預訂
BNH服务
BOOCS健康疗法
儿科
保育室
網上商店
泰国 BNH 医院
联系我们
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