Consent Forms 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
