Dermatology Partners

PATIENT CONSENT FOR PROCEDURE MINOR SURGERY/EXCISION OR SKIN BIOPSY


PATIENT CONSENT FOR PROCEDURE 
MINOR SURGERY/EXCISION OR SKIN BIOPSY

Procedure:  

I understand the nature of the procedure that has been recommended.

I have been informed of the benefits to be expected from this procedure as it compares to other available alternatives.

Possible Complications:

  • Infection
  • Bleeding
  • Allergic Reaction
  • lncomplete excision (possibly requiring additional excision)
  • Scarring

I hereby give my voluntary consent to the procedure described above.

I give my permission for a message to be left for me explaining the result of the biopsy or biopsies (initials),  

Telephone Number:
 

Date:

 

Leave this empty:

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Signature Certificate
Document name: PATIENT CONSENT FOR PROCEDURE MINOR SURGERY/EXCISION OR SKIN BIOPSY
Unique Document ID: 5717b4f5c2cb35789da88e84ca5c2ff2fb0196dd
Timestamp Audit
May 6, 2020 4:01 pm MDTPATIENT CONSENT FOR PROCEDURE MINOR SURGERY/EXCISION OR SKIN BIOPSY Uploaded by Dermatology Partners Inc - ilan@ntmatter.com IP 181.166.195.138