Consumer Protection Act and Medical Profession - Model Form of Informed Consent

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MODEL FORM OF INFORMED CONSENT

I ..................................... son of ............................... aged ................ resident of ........................................... being under the treatment of ....................................... (state here name of doctor/hospital/nursing home) do hereby give consent to the performance of medical /surgical /anesthesia/ diagnostic procedure of ....................................................... (mention nature of procedure / treatment to be performed, etc.) upon myself/upon ................................................... aged ............. who is related to me as ................................... (mention here relationship, e.g. son, daughter, father, mother,wife, etc.).

I declare that I am more than 18 years of age.I have been informed that there are inherent risks involved in the treatment / procedure. I have signed this consent voluntarily out of my free will without any pressure and in my fell senses.

Place :

Date : SIGNATURE

Time : ( To be signed by parent /guardian in case of minor)

NOTES :

1. This Consent Form should be signed BEFORE the treatment is started. These formats may be modified as per individual requirements or experiences of Hospitals / Nursing Homes.

2. These formats should be in local language and in certain cases it would be prudent to record a proper witness to signature consent.

3. Informed consent forms for various situations can be made for Nursing Homes / Hospitals. Help of lawyers may have to be taken. Detailed forms on Medical history can also be maintained. Keep all records in order and safely.

4. It is important to note that written consent should refer to one specific procedure. Obtaining a ‘blanket’ consent on admission does not have legal validity.

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Kapil999 

I was appointed to run a clinic from a hospital facility. The management one day suddenly closed the premises, with all my belongings trapped inside, without giving me any notice. The treatment of many patients was under way and they feel lost. I have complained to police for cognizable offences and also written to the state medical bodies highlighting the manner in which the premises was shut down in my absence. Are any clauses of medical act violated in this sudden and unannounced closure of a medical facility? Dr K G

Rajeev2009 

I have booked two tickets under PNR no. 4408538575, for travelling from bangalore to delhi by 12213 duranto express on 27-06-2015. But on 23-06-2015 i have received a message regarding cancellation of train, then i called railway enquiry no. 139 in this regard and they told that train cancellation can only be confirmed on 27-06-2015 morning and also advised that i have not to cancel the ticket now but after departure time of the train i have to file the TDR online through irctc website. But when i open the site next day the ticket cancellation option said that it is too late too be cancelled and TDR option said that TDR can only be filled after charting and departure. So I could not cancel my tickets and contact the irctc helpline 011- 39340000 and they told to send an email in this regard on care@irctc.co.in and they issue me a Ticket No. 1686501, But they also refused the return on 12/07/2015 by saying that I have filled the TDR very late on 03/07/2015, which had to be filled within 72 hours of train departure time. As I have said earlier wihen I make cancellation of ticket irctc website refuse it and when I file TDR irctc site told that TDR can only be file after charting done and departure of train, no other method is describe there. The method of sending email is only come to know by me when I contacted irctc helpline. This is duty of Railway and Irctc to let the passenger know about the refund procedure in case of cancellation of train. So I want back all my money which is Rs.5636.17/- as train is cancelled by railway itself.

abhi0786 

I need suggestion regarding the doctors bill. Doctor is giving me bill for 17000 for 3 day for my wife's treatment. She was not admitted to the clinic, just for three days doctor given her 2 bottle of saline everyday. Doctor is having clinic not the hospital. Can you suggest what can i do?

chit123 

I want to complain against shiv medicos in H block ashok vihar for not giving proper bills for medicines purchased and also not verifying or asking for any prescription and seselling medicines without prescriptions...

nagercoil123 

This letter is with reference to the wrong or unwanted medical procedure and hiding the truth regarding my health. Dr. S.Selvamani, Senior Consultant and Interventional cardiologist [ Reg. No: 36009] done procedures like TPI CAG Successful PTCA with BVS (Bio Resorbable Vascular Scaffold) to RCA done on 18-19-2013. I was discharged on 28/09/2013 with the discharge summary as General Condition is GOOD and I thought that I had a single vessel block and that it was cleared by PTCA method and I can continue a normal life. After Discharge,( since the hospital is around 250 Km away from my home town ) I went to another cardiologist in my home town , He took ECHO and stated the extra points like Dialated LA/LV , Grade 3 Diastolic Dysfunction , Moderate PAH , Sclerotic aortic value and minimal effusion behind inferolateral wall , moderate to severe MR, posteriorly directed wall hugging jet ( MR dp/dt 982) and the Global EF is 33 % although Meenakshi Mission Hospital and Research Centre, Madurai took ECHO they didn't reveled the above points in their discharge sheet and the cardiologist Dr.S.Selvamani ,didn't prescribed the medicines which will improve the EF % . Now I am taking T.Planeb, T.Cardarone and T. Cardace to improve the condition of the heart prescribed by an another cardiologist to improve the pumping capacity of the heart, which was failed by Dr. S. Selvamani. So I suspect that Dr. S. Selvamani didn't diagnosed or gave importance to the pumping capacity of my heart and he did wrong or unwanted procedure like PTCA and temporary pace maker installation. Dr. S. Selvamani, procedures makes me to spend around Rs.4,50,000 ( Rupees Four lacs and fifty Thousand ) at Meenakshi Mission Hospital and Research Centre, Madurai and now I am spending more money on review and other lab and ECHO procedures to improve the EF% of my heart. I strongly believe that I have been treated wrong / unwanted procedures at Meenakshi Mission Hospital and Research Centre, Madurai by Dr. S.Selvamani. I am ready to submit any medical documents and willing to go any more procedures to prove that I had been treated at Meenakshi Mission Hospital and Research Centre, Madurai in unwanted or neglected medical procedures.

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