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Soheil A. Hanjani MD FACOG FACS Obstetrics Gynecology 830 Oak Street Brockton MA 02301 508 583-4961 Fax 508 583-4732 CONSENT FORM FOR SKIN OR VULVA BIOPSY OR EXCISION Patient Name The risk and complications of the procedure include but are not limited to infection allergic reactions drug reactions bleeding pain and discomfort scaring of the skin with the possibility of poor cosmetic result possible need for re-excision. The nature of the procedure and the reason for performing it has been explained to me. The option of being referred to a dermatologist or plastic surgeon has also been discussed* I am aware that other unexpected risks or complications not discussed may occur and that no guarantees or promises were made concerning the results of any procedure or treatment. I am also aware that during the course of the proposed procedure unforeseen conditions may be revealed requiring the performance of additional procedures. I have read the above risk and complications of vulva/skin biop....

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The consent form must include: A statement that the study involves research. ... Purpose of the research. ... Procedures. ... Risks or discomforts to the subject. ... Benefits of the research to the subject. ... Treatment Alternatives. ... Costs of Participation. ... Confidentiality.

(Doctor) I certify that I have explained to the patient and/or the patient's legal representative the nature, purpose, benefits, known risks, complications, and alternatives to the proposed procedure. The patient and/or patient's legal representative has voiced an understanding of the information given.

You have the right to be given information about your proposed surgery so that you may make an informed decision to have or not have surgery. A biopsy is a surgical procedure where a sample of tissue is taken for microscopic study to determine if it is normal. It is planned to: Take out all the suspected tissue.

What is an informed consent form? The medical staff will carefully explain the surgery to you before you have it. This includes why you are having it, any risks the surgery has, and what you can expect afterward. You will also be asked to sign an informed consent form.

A statement that the study involves research, an explanation of the purposes of the research, the expected duration of a subject's participation, a description of the procedures to be followed, and if applicable identification of any experimental procedures.

Elements of Informed Consent Title of the Study. Names and Affiliations of the Primary Investigator. If a student is conducting the study, state the student's information first. Purpose of the Study. ... Subject Selection Criteria. ... Study Procedures. ... Potential Risks and Discomforts. ... Potential Benefits. ... Cost and Compensation.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232