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QualityTool Icon QualityTool:

Sample Consent Form for Cardiovascular Procedure


square iconDescription

Medical professionals can use this sample consent form to educate patients about a procedure or process and document patient consent.

The form uses graphics to depict hard-to-understand procedures and easy-to-understand language to describe potential risks from complications. Nurses and physicians review the consent form with patients and family members before the procedure to answer any questions and discuss options. The form may be completed on a computer or printed and completed on paper.

Links to the Tool:
This tool is available at: http://www.healthoutcomessciences.com/caseStudies/SampleConsentDocument.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software.)

Developer

Mid America Heart Institute, Saint Luke's Hospital

Funding Sources

Health Outcomes Sciences, LLC


QualityTool Topic

other


History

  • Release Date: 05/2008
  • Original Summary: 02/2009
Disclaimer: The inclusion of a tool in the Innovations Exchange does not constitute or imply an endorsement by the U.S. Department of Health and Human Services, the Agency for Healthcare Research and Quality or Westat of the tool or of the submitter or developer of the tool. Read more.
QualityTool Classification
Disease/Clinical Category: spacer Cardiovascular diseases
Stage of Care: spacer Acute care
Setting of Care: spacer Hospital Inpatient - Hospital Type > Community hospital, Teaching hospital; Tertiary care hospital
Patient Care Process: spacer Patient-Focused Processes/Psychosocial Care > Patient education; Provider-patient communication
QualityTool Format: spacer Fact sheet; Report
QualityTool Topic: spacer Other
Developer: spacer Mid America Heart Institute, Saint Luke's Hospital
Funding Sources: spacer Health Outcomes Sciences, LLC

 

Last updated: November 11, 2009.

 

 spacer Associated Profile:
 Revised Consent Process Based on Customized, Easy-to-Understand Form Enhances Patient Understanding and Decisionmaking for Cardiac Catheterization and Related Interventional Procedures
(7/7/08)

 
 
AHRQ Advancing Excellence in Health Care