DATE OF BIRTH: AGE: This Form has been adopted by the Texas Medical Board in accordance with the requirements of 164.052(c), Texas Occupations Code and is published in 22 Texas Administrative Code 165.6(f). The purpose of this Form is to allow the physician to obtain the required consents for an abortion to be performed on an unemancipated minor. This Form is available for downloading on the Texas Medical Board web site at www.tmb.state.tx.us.
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How to fill out the TX C-107E online
The TX C-107E form is a vital document used to obtain consent for medical procedures, particularly abortions for unemancipated minors. This guide provides clear, step-by-step instructions for filling out the form online, ensuring that all users, regardless of their legal experience, are supported throughout the process.
Follow the steps to successfully complete the TX C-107E online.
- Click the ‘Get Form’ button to access the form and open it in the online editor.
- Fill in the patient name, date of birth, and age at the top of the form accurately. Ensure that the information is clear and legible.
- In Part I, read the information about patient and parental consent requirements carefully. Familiarize yourself with the definitions and roles as outlined.
- In Part II, check the appropriate surgical and medical procedures planned to be performed. Be sure to ask questions if needed.
- Proceed to Part III, where you will review the risks and hazards. Initial next to each risk after understanding it to indicate your acknowledgment.
- In Part IV, provide your consent by initialing each statement to confirm that you understand the implications of the procedures.
- Complete the signature section in Part IV, including the printed name and date. Ensure that the signature matches the printed name.
- Complete Part V by the physician, ensuring that they sign and date after confirming that the patient understands the procedure.
- In Part VI, ensure that one parent or legal guardian initials each page and completes the consent statements.
- Have the signature in Part VII notarized. This step is crucial as it verifies consent before the planned procedure.
- Finally, save your changes, download the completed form, and print or share it as required.
Start filling out your TX C-107E online today to ensure you are prepared for your appointment.
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