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* Name and signature of the patient, or if appropriate, legal representative* Name of the hospital* Name of procedure(s)* Name of all practitioners performing the procedure and individual significant tasks if more than one practitioner* Risks* Benefits* Alternative procedures and treatments and their risks* Date and time consent is obtained* Statement that procedure was explained to patient or guardian* Signature of person witnessing the consent* Name and signature of person who explained the procedure to the patient or guardian Source: Federal Code (Title 42 C.F.R. § 482.51 (b) (2)) Interpretive Guideline A-0392<ref>{{cite webREFweb | last= | first= | date= | title=A Practical Guide to Informed Consent | url = http://www.templehealth.org/ICTOOLKIT/html/ictoolkitpage5.html | title publisher= A Practical Guide to Informed Consent | accessdate = 2015-06-30
==Sample consent forms== ===University of Virginia Health System===
==<small>References</small>==<div class='references-small'><references/></div>{{REF}}
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Neonatal circumcision consent form is a paper parents must sign when opting to have their male baby circumcised.
According to Temple Health: "Informed consent is an ethical concept—that all patients should understand and agree to the potential consequences of their care—that has become codified in the law and in daily practice at every medical institution. One of the earliest legal precedents in this area was established in 1914 when a physician removed a tumor from the abdomen of a patient who had consented to only a diagnostic procedure (Schloendorff vs. Society of New York Hospital). The judge in this case ruled that the physician was liable for battery because he violated an “individual’s fundamental right to decide what is being done with his or her body.” [Edwards 1998, Wescott 2005] The first case actually defining the elements of informed consent occurred in the late 1950s and involved a question of potential negligence and whether a patient was given sufficient information to make a decision. "
"Although the details of these laws vary from state to state, the bottom line is that failure to obtain informed consent renders any U.S. physician liable for negligence or battery and constitutes medical malpractice. [Pizzi 2001] Exceptions are made for emergencies or legally adjudicated mental incompetency or physical incapacity. "
" [AMA 1998] For example, federal regulations spell out the minimum requirements for a properly executed informed consent form (Table 2) and state that this form must be in the patient’s chart before surgery. [CFR Title 42] These regulations also stipulate that the information must be given in a language or means of communication that the patient understands. " ----
[Table 1] The Basic Features of Everyday Informed Consent
The physician (not a delegated representative) should disclose and discuss:
* The diagnosis, if known* The nature and purpose of a proposed treatment or procedure* The risks and benefits of proposed treatment or procedures* Alternatives (regardless of costs or extent covered by insurance)* The risks and benefits of alternatives* The risks and benefits of not receiving treatments or undergoing procedures
Source: AMA 1998
----
[Table 2] What’s Needed on the Informed Consent Form
* Name and signature of the patient, or if appropriate, legal representative
* Name of the hospital
* Name of procedure(s)
* Name of all practitioners performing the procedure and individual significant tasks if more than one practitioner
* Risks
* Benefits
* Alternative procedures and treatments and their risks
* Date and time consent is obtained
* Statement that procedure was explained to patient or guardian
* Signature of person witnessing the consent
* Name and signature of person who explained the procedure to the patient or guardian
}}</ref>
NOCIRC has written an exhaustive list of complications as an example of what is missing for the consent forms that parents sign in the United States.<ref>{{cite webREFweb | last= | first= | date= | title=Model Circumcision Informed Consent Form | url = http://www.nocirc.org/consent/form.php | title publisher= Model Circumcision Informed Consent FormNOCIRC | accessdate = 2015-06-30 | publisher = NOCIRC
}}</ref>
http://childrightsnurses.org/wp-content/uploads/2012/07/Informed_consent_ARIAL-8-10-R11.pdf
What's missing from the consent forms:
* Removal of the foreskin alters the mechanics of the penis
* ...
http://www.cirp.org/library/legal/conundrum/05.html
http://www.legalmatch.com/law-library/article/circumcision-legalityconsent.html
== Sample consent forms ==
http://www.virginia.edu/uvaprint/HSC/pdf/040162.pdf
*Diagnosis: Uncircumcised Newborn Male*Nature and purpose of the procedure: Not stated, relies on oral information*Additional procedures: If needed, additional procedures may be performed (i.e. if complications occur)*Practitioners: Residents may perform the procedure*Consultants, photographs, video: Consultants may be present, photographs and video may be taken for educational purposes*Tissues removed: may be used for "any lawful purpose including education and research"*Risks: risks of surgery (bleeding, infection, damage to tissue, blood vessels, nerves, organs, which may result in paralysis, cardiac arrest, brain damage, death) and specific to circumcision (bleeding, infection, deformity or need for additional surgery)*Benefits: not listed*Alternatives: not circumcise*Risks and benefits of alternatives: not listed, states parent "understands the risks of the alternative" *Risks and benefits of not undergoing the procedure
This consent form at list is somewhat honest in the list of risks. The consent form authorizes the hospital to keep and (indirectly) to sell the tissue for profit. The consent form suggests "risk of" not circumcising. The diagnosis suggests that there is something wrong with being born an "uncircumcised newborn male".<ref>{{cite webREFweb | last= | first= | date= | title=University of Virginia Health System - CONSENT FOR CIRCUMCISION OF PENIS AND ADMINISTRATION OF ANESTHESIA OR SEDATION | url = http://www.virginia.edu/uvaprint/HSC/pdf/040162.pdf | title publisher= University of Virginia Health System - CONSENT FOR CIRCUMCISION OF PENIS AND ADMINISTRATION OF ANESTHESIA OR SEDATION | accessdate = 2015-06-30
}}</ref>
===MaternOhio===
https://maternohio.securespsites.com/PEL/PEL/Shared%20Documents/26%20Newborn%20Circumcision%20Consent%20Form.pdf
*Diagnosis*Nature and purpose of the procedure*Additional procedures*Practitioners*Consultants, photographs, video*Tissues removed*Risks and benefits*Alternatives==*Risks and benefits of alternatives*Risks and benefits of not undergoing the procedure
https://www.helgemopediatrics.com/index.php?option=com_chronocontact&Itemid=46
*Diagnosis*Nature and purpose of the procedure*Additional procedures*Practitioners*Consultants, photographs, video*Tissues removed*Risks and benefits*Alternatives==*Risks and benefits of alternatives*Risks and benefits of not undergoing the procedure
http://gentlecirc.ca/consent.pdf
http://www.enatal.com/gaconsentforms/circ.pdf
==Circumcision without consent==
cases
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