| Abdominal Endoscopic Surgery |
OB Delivery |
| Abdominal Suspension of Bladder |
OR Observation Consent |
| Adenosine & Lexiscan |
|
| Adrenalectomy |
Orchidopexy |
| Anesthesia & Pain Management Spanish Version |
Orchiectomy |
| Arthroscopy of any Joint |
ORIF |
| Arthroplasty Any Joints with Mechanical Device |
OR Vendor Acknowledgment |
| Authorization To Move Vehicle and Release of Liability |
|
| Blank/Generic |
Osteotomy |
| Blank/Generic – Spanish Version |
Pancreatectomy |
| Blepharoplasty |
Parathyroidectomy |
| Blood Draw Request by Law Enforcement |
Peripheral & Visceral Nerve Blocks and or Ablations |
| Bronchoscopy |
Permanent pacemaker |
| Cataract |
Permanent Port Placement |
| Cerclage |
Phenol Injection
Nerve Bock |
| Cholecytectomy with or without CBD Exploration |
PICC Midline Consent |
| Circumcision |
Port Placement Consent |
Closed
Reduction with IV Moderate Sedation |
Prostatectomy |
| Colectomy (Partial) |
Pyeloureteroplasty |
| Colectomy (Total) |
Radiofrequency Ablation Consent |
| Colporrhaphy Repair |
Ramirez Ear Exam Disclosure and Consent |
| Conization of Cervix |
Ramirez – Adenoidectomy Consent |
| Cystectomy (Partial) |
Ramirez – BMT with tubes Consent |
| Cystectomy (Radical) |
Ramirez – BMT-Adenoidectomy Consent |
| Cystectomy (Total) |
Ramirez – Direct laryngoscopy and biopsy Consent |
| D & C of Uterus |
Ramirez – Functional Endoscopic Sinus Surgery Consent |
| Dobutamine |
Ramirez – Mastoidectomy Consent |
| Dr Shaw’s Epidural Injection |
Ramirez – Parotidectomy Consent |
| Echocardiogram and-or Cardioversion Disclosure |
Ramirez – Septoplasty and turbinates Consent |
| Endoscopy Lower |
Ramirez – T and A and BMT Consent |
| Endoscopy Upper |
Ramirez – Tonsillectomy Consent |
| Enterocele Repair |
Ramirez – Tonsillectomy and Adenoidectomy Consent |
| ERCP |
Refusal of Advised medical Care/Treatment |
| Exploration of Kidney or Perinephric Mass |
Refusal to Permit Blood Transfution |
| Fallopian Tube Occlusion & Sterilization |
Removal of Cervix |
| Hip Arthroplasty Disclosure and Consent |
Removal of Fibroids (Myomectomy) |
| HIV Test Acknowledgement |
Rhinoplasty |
| HIV Test Consent(Employees) |
Selective Salpingography & Fallopian Tube Recanalization |
| HIV Antibody Testing Consent (Patients) |
|
| Hysterectomy Consent |
Septoplasty |
| Hysterectomy Consent *Spanish* |
|
| IV Drug User Release for Outpt IV Med Administration |
Shoulder Arthroplasty Disclosure and Consent |
| Knee Arthroplasty Disclosure and Consent |
Splenectomy |
| Kyphoplasty or Vertebroplasty |
Stapedectomy |
| Ligamentous Reconstruction of Joints |
Stent Placement in Esophagus |
| Lumbar Puncture |
Stent Placement in Intestinal Tract |
| Lung Resection (Segmental) |
Thoracentesis |
| Mastectomy (Modified Radical) |
|
|
Thoracotomy |
| Nephrectomy (Radical) |
Thorax Endoscopic Surgery |
| Nephrectomy |
Thyroidectomy |
| Nephrolithotomy & Pyelolithotomy |
Tracheostomy (Open) |
| Nerve Block |
Transesophageal
Echocardiogram and Electrical Cardioversion |
| Neuroaxial procedures (Injections into or around Spine) |
Transfusion Disclosure and Consent |
|
Tympanoplasty with Mastoidectomy |
|
Ureteral Reimplantation |
|
Ureteral-Renal Stone |
|
Ureterectomy |
|
Ureterolithotomy |
|
Ureterolysis |
|
Ureteroplasty |
|
Urinary Diversion |
|
Uterine Suspension |
|
Vasectomy |
|
|
|
Procedure Risks |
|
Procedure Risks Digestive System Endocrine and Integumentary System Procedure Risks |
|
Procedure Risks Ear and Respiratory System Treatments and Procedures |
|
Procedure Risks Eye Treatments and Procedure |
|
Procedure Risks Female Genital-Reproductive Systems pg 1 |
|
Procedure Risks Female Genital-Reproductive Systems pg2 |
|
Procedure Risks Musculoskeletal System Treatments and Procedure |
|
Procedure Risks Radiology |
|
Procedure Risks Urinary System-Male Genital System pg 1 |
|
Procedure Risks Urinary System-male genital Systems pg 2 |
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