Ultrasound Consent Forms

Obtaining consent is the commonest and most vital part of any hospital setting. It is a process that all doctors should be well acquainted with whether they belong to medicine, surgery or radiology department.

Prerequisites of consent taking

The doctor must make sure he is aware of the patient’s clinical history, his physical examination findings, and his past medical or surgical history before taking consent for any new procedure. He should also make certain whether the patient needs a specific procedure or not and confirm it from the doctor who referred the patient to him. The site and side of the patient on which the procedure is to be performed should be clearly noted. The patient must also be checked for allergy to the ultrasound gel used for the procedure.

Who must take the consent?

The ideal situation is where the consultant takes the consent himself as he knows the procedure and its consequences better than any staff. However, a resident or intern is equally capable of obtaining consent. It should be cross-checked by another fellow doctor and then again by the nurse in charge.

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Ultrasonography

Ultrasonography also called Ultrasound is a noninvasive, diagnostic procedure commonly done by a Radiologist. It is the detailed image of soft tissues obtained by passing sound waves through the body part to be examined.

It is a safe procedure without any harmful radiations and hence it is frequently performed on pregnant ladies. Different areas can be examined by this technique, like chest/breast, neck, abdomen, arms and legs. There is another technique called Doppler Sonography, where blood flow to various body parts can be checked. Ultrasound of the heart is commonly called Echocardiography performed by Cardiologists.

Patient Privacy:

Privacy of patient matters a lot when it comes to doing Ultrasound, especially in female patients. It is to be made certain that before doing any procedure, the patient must be warned about it beforehand and minimal required exposure must be done only after taking properly documented consent. A female nurse/ doctor must accompany all female patients at all times. No other hospital personnel is allowed to invade the parameters during the procedure. Patient’s ultrasound report must be delivered only to him/her and any ambiguity must be cleared with compassion.

Elements of an ultrasound consent form

  • Patient’s biodata: Name, age, gender, mode of admission or referral, hospital/clinic registration number, phone number, and identity card number.
  • A brief history of the patient’s current and past illnesses, if any.
  • A complete and easy-to-understand delineation of the procedure, its method, and duration.
  • Consent about the degree of exposure required for the procedure especially for female patients.
  • Any complications related to the procedure, both during and after the ultrasound, like allergy, pain, etc.
  • Signature of the patient – if an adult – along with his full name and identification. In case of a minor patient, the signature of his immediate relatives like parents must be taken.
  • Next-to-kin person with a contact number in case of any emergency.



File: Word (.docx) 2007 & latest Size 56 Kb | Download


Ultrasound History & Screening Form



File: Word (.docx) 2007 & latest Size 38 Kb | Download


Simi Karton

Dr. Simi Karton is a regular contributor to National Science Quarterly and an enthusiastic Lakers fan. She recently collaborated on a manuscript with friends and colleagues. Dr. Simi Karton, entitled Parkinsons and the Genetic Response to Eastern Medicine, in which she and Dr. Inshal presented research compiled during a summer spent in United States. She currently resides in Los Angeles with her husband. This website is a voluntary work of Dr. Karton to provide people with useful health related information stuff at an easy approach. The information has been collected from different sources at one place.

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