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Sterilization consent form california non federally funded

STERILIZATION CONSENT FORM (NON-FEDERALLY FUNDED) - cdph ca 2025

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The document is a Sterilization Consent Form from the California Department of Public Health, outlining the process and requirements for individuals consenting to sterilization. It emphasizes that consent is voluntary, can be withdrawn at any time without affecting access to federal benefits, and that sterilization is a permanent procedure. The form includes sections for the individual's statement, interpreter's statement, and physician's statement, ensuring that all parties understand the nature, risks, and alternatives to sterilization.

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What is a PM330 consent form?

CONSENT FORM PM 330 State of California -- Health and Human Services Agency NOTICE Department of Health Services YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL NOT RESULT IN THE WITHDRAWAL OR WITHHOLDING OF ANY BENEFITS PROVIDED BY PROGRAMS OR PROJECTS RECEIVING FEDERAL FUNDS.

Does Medi-Cal cover sterilization?

Medi-Cal covers sterilization services for people 21 years of age and older, including vasectomies and tubal ligation.

Does CPT code 58661 require a consent form?

Removal of Fallopian Tubes If CPT codes 58661 and 58700 are elective sterilization procedures, there is no TAR requirement. Consent Form (PM 330) remains a requirement in elective sterilization procedures.

Is spousal consent required for sterilization?

The consent of the spouse is not required even if it incidentally will result in the sterilization of the patient. Statutes in Georgia, North Carolina, and Virginia requie the written consent of the patients spouse to voluntary sterilizations.

What consent is required for sterilization?

STATEMENT OF PERSON OBTAINING CONSENT To the best of my knowledge and belief the individual to be sterilized is at least 21 years old and appears mentally competent. He/She knowingly and voluntarily requested to be sterilized and appears to understand the nature and consequences of the procedure.

sterilization consent form california

Pm330 sterilization consent form Sterilization consent form PDF Consent form PM 330 Spanish PM 330 form PDF PM 284 sterilization consent form Requirements to get your tubes tied in California Tubal ligation consent form DHCS sterilization booklet

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What is a sterilization consent form?

In 1974, the federal sterilization consent form (SCF) was created for those with publicly funded insurance to document appropriate informed consent by a clinician for sterilization procedures.

What are the criteria for sterilization?

Interval sterilization should be performed within 7 days of the menstrual period (in the follicular phase of the menstrual cycle). Post-partum sterilization should be done after 24 hours up to 7 days of delivery. Sterilization with medical termination of pregnancy (MTP) can be performed concurrently.

STERILIZATION CONSENT FORM (NON-FEDERALLY FUNDED) - cdph ca 2025

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What is a PM330 consent form?

Does Medi-Cal cover sterilization?

Does CPT code 58661 require a consent form?

Is spousal consent required for sterilization?

What consent is required for sterilization?

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What is a sterilization consent form?

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