Minor Surgery Consent 2 - Pennine GP Training



STEROID JOINT & SOFT TISSUE INJECTION CONSENT

BRIG ROYD SURGERY

Mental capacity in this context is assumed. Consider application of MCA test if appropriate and record in notes. ( see BRS policy)

Name of patient: ………………………………………….. DOB: ……………

The following issues have been discussed

• The nature of the procedure and the reason for the injection has been explained as well as alternative treatments available.

• The potential risks has been explained taking in to account the risks that are important to the patient e.g. bleeding, bruising, infection, menstrual irregularity, post injection pain, soft tissue atrophy and de-pigmentation of the skin.

• Advice about aftercare has been provided.

• Any allergies including dressings and antibiotics?......................

• Patient has had the opportunity to ask questions to clarify any information given.

• Please consider reading the ARCUK patient information leaflet on joint injection.

Procedure…………………………………………………………..….GP Dr

Signature……………………….

I…………………………….. …………(print name) consent to the minor surgical procedure as described to me by my doctor. I have read and understood the information detailed above and understand fully the reasons for the procedure.

Signed………………………………………….Date………….

One copy for patient

One copy to records

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