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  • Dmap 741 Hysterectomy Consent Form

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Hysterectomy Consent Form OHP 741 (7/16) Hysterectomy Consent Health Systems Division Operations and Policy Patient s name Medicaid ID Complete only one of the .

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Hysterectomy Consent Do not use Consent to Sterilization forms (OHP 742A and OHP 742B) for hysterectomies. Hysterectomies for the sole purpose of sterilization are not covered. See OAR 410-130-0580 for more information about hysterectomy consent procedures.

During the surgery the whole uterus is usually removed. Your doctor may also remove your fallopian tubes and ovaries. After a hysterectomy, you no longer have menstrual periods and cannot become pregnant.

There are different ways to perform a hysterectomy, including: Laparoscopic – keyhole surgery, performed through small cuts in your abdomen, using a tube with a camera (laparoscope) Vaginal – the surgery is performed through your vagina. Abdominal – performed via a cut in your lower abdomen.

hysterectomy consent form may be a hospital form, a physician-designed form or a written. statement by the person who secures authorization. To be acceptable, however, the form. must include the following: • A statement that the procedure will render the patient permanently sterile and.

The most common reasons for having a hysterectomy include: heavy periods – which can be caused by fibroids. pelvic pain – which may be caused by endometriosis, unsuccessfully treated pelvic inflammatory disease (PID), adenomyosis or fibroids. prolapse of the uterus.

That's because hysterectomy can be considered to be a sterilization procedure, since pregnancy cannot occur afterwards. Hysterectomy, therefore, falls under the protections enabling women to obtain sterilization procedures without spousal consent.

I understand that a hysterectomy (surgical removal of my uterus) is medically necessary and I have agreed to this operation. I acknowledge that I have been advised orally and in writing that the hysterectomy will cause me to be permanently incapable of reproducing (become sterile).

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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