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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
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BOOCS健康疗法
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GENERIC CONSENT FORM FOR MEDICAL SURGERY / PROCEDURE / INVESTIGATION
If you are human, leave this field blank.
Generic Consent Form For Medical Surgery / Procedure / Investigation
Name of patient/ Name of guardian
Authorize person for the patient, whose name is ...
Relationship
Father
Mother
Relatives
Other (Please specified)
Other (Please specified)
Identification No. (guardian)
Issue Place (guardian)
State/Province
Issue Date (guardian)
Expiration Date (guardian)
Current Address (guardian)
Country
Passport/Valid ID picture (guardian)
Drop a file here or click to upload
Choose File
Maximum upload size: 67.11MB
I have received the detailed information from the physician concerning the proposed surgery , procedure , medication administration and/or investigations involved along with the following:
Patient's condition
Procedure's name
Length Of Operation
Type of anesthesia
Type of anesthesia
Localized anesthesia
Regional anesthesia / Deep Sedation
Moderate Sedation
Success rate of the surgery or procedure
Risks and complications from refusal of surgery or procedure
Risks and complications from surgery or procedure
Expected outcome
Alternative treatment
Estimated cost of operation
As the patient's condition reasonably precludes the granting informed consent, The above information has been explained to the responsible guardians/relatives. The cost and treatment is hereby authorized.
Signature (guardian)
Clear
State why the patient is not able to given consent personally (or sign this form)
Minor - any unmarried male or female whose age has not reached the age of consent (20 years old)
Physical / Mental dosorder
Other (Please specify)
Other (Please specify)
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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