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22, 51305.3 - Informed Consent Process for Sterilization. (a) An individual has given informed consent only if: (1) The person who obtained consent for the sterilization procedure: (A) Offered to answer any questions the individual to be sterilized may have concerning the procedure.
A properly completed Sterilization Consent Form (HHS-687) is required for all sterilization-related claims. This includes hospital claims and professional services (surgeon and anesthesia). All other requirements and instructions for the Sterilization Consent Form must be followed to ensure the consent form is valid.
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.
What is pm330 consent form? A completed PM 330 Sterilization Consent Form must accompany all claims directly related to the sterilization surgery. This requirement extends to all providers, attending physicians, surgeons, assistant surgeons, anesthesiologists and facilities.
30 days (but not more than 180 days) must pass after the sterilization consent form has been signed. The 30 days starts the day after the consent is signed. Private Pay patients may request in writing that procedure be performed in less than 30 days.
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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.
1. This form is called an informed consent form. Its purpose is to inform me about the hysterectomy procedure.
1. This form is called an informed consent form. Its purpose is to inform me about the hysterectomy procedure.

nj fd hysterectomy form