Employee & Physician Portal

Consent Forms


Abdominal Endoscopic Surgery OB Delivery
Abdominal Suspension of Bladder
Adrenalectomy Orchidopexy
Anesthesia & Pain Management    Spanish Version Orchiectomy
Arthroscopy of any Joint ORIF
Arthroplasty Any Joints with Mechanical Device
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
Cerclage Phenol Injection
Nerve Bock
Cholecytectomy with or without CBD Exploration PICC Midline Consent
Circumcision Port Placement Consent
Reduction with IV Moderate Sedation
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
Ramirez – Mastoidectomy Consent
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
Removal of Fibroids (Myomectomy)
Selective Salpingography & Fallopian Tube Recanalization
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)
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
Urinary Diversion
Uterine Suspension
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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