Anaesthesia form and consent
Anaesthesia form
When you need to be admitted for an operation or procedure, you will receive an anaesthetic form to fill in either from your Surgeon or from the hospital. This is our equivalent of the usual doctors’ form from the surgery that you know well. Please do this yourself (or ask a responsible relative), read the details and sign in the TWO spaces provided on the back page. There are four sections:
Anaesthesia form
When you need to be admitted for an operation or procedure, you will receive an anaesthetic form to fill in either from your Surgeon or from the hospital. This is our equivalent of the usual doctors’ form from the surgery that you know well. Please do this yourself (or ask a responsible relative), read the details and sign in the TWO spaces provided on the back page. There are four sections:
- Section A is on the back page: Agreement between Anaesthesiologist and patient
- Section B on the front page: Fill in your personal and medical aid details, ID, address etc. Enter the Authorization Number. Find out what plan you are on and enter it. It avoids confusion and simplifies discussion around rates. We will complete the bottom half of the form.
- Section C: is overleaf and we can use this for record keeping
- Section D on the inside: This is your medical history which may influence our treatment
| Anaesthetic Form.pdf |
Consent
We need your consent to proceed with the anaesthetic independently of the Surgeon and the hospital. The patient, parent, guardian or mandated person must also state, by signing a consent form before the procedure, that he has been informed of the benefits, risks, costs and consequences generally associated with the specific type of anaesthetic.
We need your consent to proceed with the anaesthetic independently of the Surgeon and the hospital. The patient, parent, guardian or mandated person must also state, by signing a consent form before the procedure, that he has been informed of the benefits, risks, costs and consequences generally associated with the specific type of anaesthetic.