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Park Street-3rd Floor Madison, WI 53715

Park Street-3rd Floor Madison, WI 53715 2025

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223 votes

The document is a consent form for patients at Madison Surgery Center, outlining the patient's agreement to undergo specified medical procedures, including operations, anesthetics, and transfusions. It details the risks, benefits, and alternatives associated with these procedures, as well as the patient's rights to ask questions and understand the implications of their consent. The form also addresses issues related to anesthesia, blood transfusions, and the handling of any removed tissues.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your Patient Name and Date of Birth (DOB) at the top of the form. This information is essential for identifying your medical records.
In the section labeled 'CONSENT TO OPERATIONS, ANESTHETICS, DIAGNOSTIC RADIOLOGY, TRANSFUSION, OR OTHER PROCEDURES', clearly specify the procedure you are consenting to by filling in the blank space provided.
Indicate which side of the body is involved in the procedure by checking either 'RIGHT' or 'LEFT'.
Review page 2 of the form carefully. If you have any changes or limitations to add, write them in the designated area.
Sign and date where indicated to confirm your understanding and consent. If someone else is signing on your behalf, ensure they print their name and relationship.
Finally, if applicable, have an interpreter or witness sign as required. Ensure all signatures are completed before submitting.

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Versions	Form popularity	Fillable & printable
2021	4.7 Satisfied (52 Votes)
2020	4.8 Satisfied (57 Votes)
2018	4.3 Satisfied (223 Votes)

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