CONSENTS Kaleida Health Education Department. The purpose of a written consent is to provide visible proof of consent. Purpose of a Consent.

CONSENTSCONSENTS

Kaleida Health Education Kaleida Health Education DepartmentDepartment

The purpose of a written consent is to provide visible proof of consent.

Purpose of a Consent

If there is only a verbal conversation between the patient and physician in which consent is given, this may be difficult to prove in a court of law

Purpose of a Consent

Three Components of an Three Components of an Informed ConsentInformed Consent

Explanation of Explanation of the procedure by the procedure by the physician. the physician.


Understanding Understanding by the person by the person giving consent. giving consent.

I don’t understand!


A witnessed A witnessed signature.signature.

Explanation by the PhysicianExplanation by the Physician

Obtaining valid Obtaining valid consent is the consent is the responsibility of the responsibility of the physician.physician.


The physician The physician explains the explains the procedure or procedure or treatment to be treatment to be performed. performed.


The discussion must include a The discussion must include a disclosure of the proposed disclosure of the proposed treatment or surgery risks, treatment or surgery risks, benefits, consequences and benefits, consequences and alternatives, alternatives, including that of including that of no treatmentno treatment, and should be , and should be accompanied by voluntary, accompanied by voluntary, competent and understanding competent and understanding consent on the part of the consent on the part of the patient. patient.

Understanding by the Person Understanding by the Person Giving ConsentGiving Consent

The consent must be an The consent must be an informedinformed consent. consent.

Understanding by the Person Understanding by the Person Giving ConsentGiving Consent

The patient (or person deemed to The patient (or person deemed to have the responsibility to have the responsibility to consent) must have had: consent) must have had:

– the opportunity to discuss the the opportunity to discuss the treatment or surgery, and treatment or surgery, and

– has had time to ask any questions has had time to ask any questions he/she may have about the he/she may have about the procedure to be performed with a procedure to be performed with a physician (or dentist, where physician (or dentist, where appropriate). appropriate).

I have questions

!

A Witnessed SignatureA Witnessed Signature

Physicians, nurses and clerical Physicians, nurses and clerical personnel can witness the personnel can witness the signingsigning of of a consent a consent

Witness of a Consent Witness of a Consent If you witness a consent, If you witness a consent,

this means that you this means that you watchedwatched the patient sign the patient sign the consent and he/she the consent and he/she was not being forced into was not being forced into signing it. signing it.

You should You should NEVERNEVER sign sign as a witness unless you as a witness unless you have actually have actually watchedwatched the person sign the the person sign the consent. consent.

When signing your name When signing your name as the witness, you must as the witness, you must include your job title include your job title after your name.after your name.

Who Can Sign Their Own Who Can Sign Their Own Consent Form?Consent Form?

Prior to the commencement of a Prior to the commencement of a procedure, the Kaleida Health procedure, the Kaleida Health consent form must be signed by consent form must be signed by one of the following in order of one of the following in order of preference:preference:

Who Can Sign Their Own Who Can Sign Their Own Consent Form?Consent Form?

The patient if they are older than 18 years of age

A lawfully appointed guardian

A New York State Surrogate Decision Making Committee

(contact Risk Management)

An actively involved parent

An actively involved adult child

An actively involved spouse

A court (Risk Management should be contacted)

If the legally appointed person on the above list objects to the proposed treatment of the mentally disabled patient, then an application must be made to the appropriate court. (Contact Risk Management)

Minors and Informed ConsentMinors and Informed Consent With respect to minors, the general rule is With respect to minors, the general rule is

that a health care provider must obtain that a health care provider must obtain the informed consent of a parent or the informed consent of a parent or guardian before treatment can begin.guardian before treatment can begin.

The law generally assumes that a The law generally assumes that a competent individual will act on the competent individual will act on the minor’s behalf.minor’s behalf.

Minor is usually defined as a person under Minor is usually defined as a person under 18 years of age.18 years of age.

Emancipated MinorEmancipated Minor

A person less than eighteen years of A person less than eighteen years of age and is or has at any time been age and is or has at any time been married, or is the parent of a child married, or is the parent of a child

Emancipated MinorEmancipated Minor States that he or States that he or

she is self she is self supporting and is supporting and is living away from living away from his or her parents his or her parents (based on the (based on the reasonable belief reasonable belief of the physician or of the physician or staff person staff person obtaining patient obtaining patient information).information).


Has been determined to be Has been determined to be emancipated by a court.emancipated by a court.


May give effective consent for May give effective consent for medical treatment for himself or medical treatment for himself or herself.herself.

Privacy Rights of MinorsPrivacy Rights of Minors If a health care provider believes a If a health care provider believes a

minor has been subjected to abuse or minor has been subjected to abuse or neglect by the parent or legal guardian, neglect by the parent or legal guardian,

or could be endangered if the parent or or could be endangered if the parent or legal guardian is treated as the minor’s legal guardian is treated as the minor’s personal representative, personal representative,

the health care provider may deny a the health care provider may deny a parent or legal guardian to exercise the parent or legal guardian to exercise the privacy rights, privacy rights,

may deny a parent or legal guardian’s may deny a parent or legal guardian’s request to inspect or copy the minor’s request to inspect or copy the minor’s protected health information, and protected health information, and

may refuse to disclose the minor’s may refuse to disclose the minor’s protected health information to the protected health information to the parent or legal guardian.parent or legal guardian.

Who Can Sign Consent for a Who Can Sign Consent for a Minor?Minor?

A A minorminor is defined as a person under is defined as a person under 18 years of age.18 years of age.

MinorsMinors

With respect to minors, the general rule is With respect to minors, the general rule is that a health care provider must obtain that a health care provider must obtain the informed consent of a parent or the informed consent of a parent or guardian before can treat.guardian before can treat.

The law generally assumes that a The law generally assumes that a competent individual will act on the competent individual will act on the minor’s behalf.minor’s behalf.

Unemancipated MinorUnemancipated Minor

When a patient is an unemancipated When a patient is an unemancipated minor, the consent of a parent or minor, the consent of a parent or guardian is required guardian is required

Parent or GuardianParent or Guardian

Note: A Guardian must have written documentation to Note: A Guardian must have written documentation to evidence his/her legal authority to consent. evidence his/her legal authority to consent.

A copy of documentation must be placed in the patient’s A copy of documentation must be placed in the patient’s medical record. medical record.

However, if the parent or legal guardian is not reasonably However, if the parent or legal guardian is not reasonably available to sign the consent form, the physician may available to sign the consent form, the physician may provide treatment for the unemancipated minor based on provide treatment for the unemancipated minor based on the parent or legal guardian’s verbal consent by the parent or legal guardian’s verbal consent by telephone and agreement to sign the Authorization Form telephone and agreement to sign the Authorization Form at the first available opportunity. at the first available opportunity.

Two individuals on the same telephone line at the same Two individuals on the same telephone line at the same time must hear the verbal consent of the parent or time must hear the verbal consent of the parent or guardian (Policy # LE.10 Treatment of Unemancipated guardian (Policy # LE.10 Treatment of Unemancipated Minor).Minor).

ExceptionsExceptions A consent is A consent is NOT REQUIREDNOT REQUIRED for the unemancipated minor when: for the unemancipated minor when:

A medical emergency existsA medical emergency exists

The minor is pregnantThe minor is pregnant

Treating sexually transmitted diseasesTreating sexually transmitted diseases

Performance of HIV testing is being conductedPerformance of HIV testing is being conducted

Child abuse is suspectedChild abuse is suspected

Treating alcohol abuse, alcoholism, and/or substance abuseTreating alcohol abuse, alcoholism, and/or substance abuse

The unemancipated minor is sexually active and the physician determines The unemancipated minor is sexually active and the physician determines that the unemancipated minor has the ability to understand and appreciate that the unemancipated minor has the ability to understand and appreciate the nature and consequences of the proposed health care service, the nature and consequences of the proposed health care service, treatment or procedure and such minor can make an informed decision, treatment or procedure and such minor can make an informed decision, such minor may consent to the provision of health services or treatment such minor may consent to the provision of health services or treatment for sexually related activities. for sexually related activities.

Sole and Joint Custody IssuesSole and Joint Custody Issues

Divorced parents have equal Divorced parents have equal authority to request health authority to request health informationinformation

If a court order clearly permits If a court order clearly permits only one parent to make health only one parent to make health care decisions for a minor, care decisions for a minor, then only that parent has the then only that parent has the right to access protected right to access protected health information regarding health information regarding the child. the child.

Note:Note: If the case is emergent in If the case is emergent in

nature, the physician may nature, the physician may proceed proceed


If the court order is not clear as to which If the court order is not clear as to which parent has authority to make health careparent has authority to make health care

decisions, both parents may access the decisions, both parents may access the minor’s protected health information.minor’s protected health information.

If a parent did not sign paternity papers, If a parent did not sign paternity papers, that parent must petition the court to that parent must petition the court to establish paternity in order to consent.establish paternity in order to consent.


If parents with joint custody disagree If parents with joint custody disagree on the course of treatment, a on the course of treatment, a meeting between the attending meeting between the attending physician and the parents should physician and the parents should take place.take place.

AdoptionAdoption

Biological parents’ rights Biological parents’ rights are terminated upon are terminated upon adoption.adoption.

Documentation that is Documentation that is required in the patient’s required in the patient’s chart:chart:

– The court order of adoption The court order of adoption must be in the patient’s must be in the patient’s chart chart

Pending AdoptionPending Adoption

County or private agency has custody County or private agency has custody of minor while adoption is pending.of minor while adoption is pending.

Documentation that is required in the Documentation that is required in the patient’s chart:patient’s chart:– A signed adoption placement agreement A signed adoption placement agreement

with private agency with private agency

Military Power of AttorneyMilitary Power of Attorney

Parents in the military obtain Parents in the military obtain power of attorney when power of attorney when leaving their children with a leaving their children with a caretaker while they are caretaker while they are serving in the military.serving in the military.

Call Risk Management to Call Risk Management to review paperwork. They review paperwork. They may decide to contact may decide to contact parents based on the nature parents based on the nature of the procedure.of the procedure.

Alternatives to Parental ConsentAlternatives to Parental Consent

Usually occurs due to the neglect, failure, or absence of a Usually occurs due to the neglect, failure, or absence of a parent.parent.

If the guardian is not the parent, the guardian must provide If the guardian is not the parent, the guardian must provide written documentation to evidence legal authority to written documentation to evidence legal authority to consent.consent.

A copy of the documentation should be placed in the A copy of the documentation should be placed in the minor’s chart.minor’s chart.

If the legal guardian or other person who has authority to If the legal guardian or other person who has authority to make health care decisions for the child refuses to sign a make health care decisions for the child refuses to sign a consent, contact Risk Management who will contact an consent, contact Risk Management who will contact an attorney.attorney.

If it is an emergency, you are permitted to treat without a If it is an emergency, you are permitted to treat without a consent. Document in the chart. consent. Document in the chart.

Foster ParentsFoster Parents Generally do not have authority to consent to health care Generally do not have authority to consent to health care

treatment.treatment.

In general, the party that has the capacity to make health In general, the party that has the capacity to make health care decisions is the biological parent(s) (if parental rights care decisions is the biological parent(s) (if parental rights have not been terminated) or the custodian (i.e. the have not been terminated) or the custodian (i.e. the county).county).

In some instances, County Social Services Department may In some instances, County Social Services Department may issue a letter authorizing a foster parent to consent to issue a letter authorizing a foster parent to consent to medical treatment.medical treatment.

Documentation that is required in the patient’s chart:Documentation that is required in the patient’s chart:– Letter from County Social Services Department authorizing Letter from County Social Services Department authorizing

foster parent to consent to medical treatment.foster parent to consent to medical treatment.

CustodianCustodian

Refers to a legal relationship that is Refers to a legal relationship that is established by court order, in which established by court order, in which one individual, referred to as the one individual, referred to as the Custodian, is given legal authority Custodian, is given legal authority over, and the corresponding legal over, and the corresponding legal responsibility for, the physical care of responsibility for, the physical care of another individual.another individual.

Other than the ParentsOther than the Parents

NOTE:NOTE:

– Any person other than the parent(s) Any person other than the parent(s) must have the required legalmust have the required legal

– Documentation giving consent in the Documentation giving consent in the patient’s chart prior to being sent to the patient’s chart prior to being sent to the surgical holding area.surgical holding area.

Who Can Sign Consent For Patients who Who Can Sign Consent For Patients who Lack Capacity to Make Their Own Health Lack Capacity to Make Their Own Health

Care Decisions?Care Decisions?

Capacity to make health care decisions means: Capacity to make health care decisions means:

the ability to understand and appreciate the nature the ability to understand and appreciate the nature and consequences of health care decisionsand consequences of health care decisions

including the benefits and risks and alternatives to including the benefits and risks and alternatives to any proposed health care so that an informed any proposed health care so that an informed decision about the procedure or treatment can be decision about the procedure or treatment can be reached.reached.

Health Care ProxyHealth Care Proxy

is someone that the patient has is someone that the patient has identified to act on his/her behalf identified to act on his/her behalf when medical decisions must be when medical decisions must be made. Written documentation to made. Written documentation to evidence his/her legal authority to evidence his/her legal authority to consent must be placed in the consent must be placed in the patient’s medical record.patient’s medical record.

Legal GuardianLegal Guardian

-has the care, custody and control of -has the care, custody and control of the incompetent person. the incompetent person.

The legal guardian must provide The legal guardian must provide written documentation to evidence written documentation to evidence his/her legal authority to consent. A his/her legal authority to consent. A copy of the documentation must be copy of the documentation must be placed in the patient’s medical placed in the patient’s medical record. record.

Lack of CapacityLack of Capacity

If the patient lacks capacity to consent, If the patient lacks capacity to consent, then consent may be provided by (in order then consent may be provided by (in order of preference):of preference):– A lawfully appointed guardianA lawfully appointed guardian– An actively involved spouseAn actively involved spouse– An actively involved parentAn actively involved parent– An actively involved adult childAn actively involved adult child– A Surrogate Decision Making Committee A Surrogate Decision Making Committee

(Article 80, Mental Hygiene Law).(Article 80, Mental Hygiene Law).– A Court (Risk Management should be A Court (Risk Management should be

contacted)contacted)

WrittenWritten ConsentConsent ProcedureProcedure Obtaining consent is the responsibility of the physician who will Obtaining consent is the responsibility of the physician who will

perform the surgical operation or the procedure.perform the surgical operation or the procedure.

Necessary blanks that must be filled in prior to the signing of the Necessary blanks that must be filled in prior to the signing of the consent (witnessing).consent (witnessing).

PersonPerson RelationshipRelationship Physician(s) namePhysician(s) name Name of patientName of patient Operation(s)/Procedure(s)Operation(s)/Procedure(s) Non-technical language for operation/procedureNon-technical language for operation/procedure

NoteNote: Nursing or clerical personnel may transcribe the name of the : Nursing or clerical personnel may transcribe the name of the operation(s)/procedure(s) and the lay person description operation(s)/procedure(s) and the lay person description onto the authorization form, if the information is supplied by the onto the authorization form, if the information is supplied by the physician as contained in a written physician order.physician as contained in a written physician order.

Contents of the FormContents of the Form

Review the contents of the form Review the contents of the form with the consenting party. with the consenting party.

Have consenting party complete all Have consenting party complete all sections of the consent form. Assess the sections of the consent form. Assess the consenting party’s understanding. If the consenting party’s understanding. If the consenting party has consenting party has anyany questions, you questions, you do notdo not have them sign the consent form. have them sign the consent form. The physician needs to answer these The physician needs to answer these questions questions beforebefore the consent is signed. the consent is signed.

The person should sign with The person should sign with his/her legal signaturehis/her legal signature

This means that the person signs his/her full This means that the person signs his/her full name.name.

ForFor ExampleExample:: John Jones John Jones

NOTNOT J. JonesJ. Jones

Helen SmithHelen SmithNOTNOT

Mrs. Joseph SmithMrs. Joseph Smith

You sign as a witnessYou sign as a witness

This means that you This means that you watchedwatched the the person sign the consent and he/she person sign the consent and he/she was not being forced into signing it. was not being forced into signing it. You should sign with your full name You should sign with your full name and job title (example RN).and job title (example RN).

Telephone ConsentTelephone Consent

Obtaining consent over the telephone is Obtaining consent over the telephone is acceptable only in accordance with the following:acceptable only in accordance with the following:

– If the person giving the consent is not physically present If the person giving the consent is not physically present and is unavailable to provide written consent, the and is unavailable to provide written consent, the physician’s conversation with the consenting party must physician’s conversation with the consenting party must be witnessed by 2 members of the Kaleida health staff be witnessed by 2 members of the Kaleida health staff and must be documented by the physician and witness and must be documented by the physician and witness in the patient’s medical record.in the patient’s medical record.

– The Authorization for Medical and /or Surgical Treatment The Authorization for Medical and /or Surgical Treatment form must be completed as soon as practical thereafter form must be completed as soon as practical thereafter

Authorization for Medical and/or Surgical Authorization for Medical and/or Surgical TreatmentTreatment

When is this obtained?When is this obtained?

For all operative procedures and those For all operative procedures and those high-risk treatments designated by high-risk treatments designated by the medical staff as requiring the medical staff as requiring consent.consent.

Surgical Operations and/or procedures Surgical Operations and/or procedures

requiring written informed consentrequiring written informed consent..

All surgical operations an/or procedure and/or those involving the All surgical operations an/or procedure and/or those involving the administration of general or regional anesthesia or conscious administration of general or regional anesthesia or conscious sedation including, sedation including, but not limited tobut not limited to::

AngiographyAngiography ArthrogramArthrogram BronchogramBronchogram BronchoscopyBronchoscopy Caesarean SectionCaesarean Section Cardiac CatheterizationCardiac Catheterization Elective CardioversionElective Cardioversion Electroshock TherapyElectroshock Therapy IABP InsertionIABP Insertion Pacemaker InsertionPacemaker Insertion Subdural BlockSubdural Block Transesophageal EchocardiogramTransesophageal Echocardiogram Vaginal delivery and related proceduresVaginal delivery and related procedures

OthersOthers AmniocentesisAmniocentesis Arterial Line InsertionArterial Line Insertion BiopsyBiopsy Blood PatchBlood Patch Cardiac Stress TestCardiac Stress Test Chest Tube InsertionChest Tube Insertion Intervascular Contrast StudiesIntervascular Contrast Studies CVP InsertionCVP Insertion HemodialysisHemodialysis Induced PneumothoraxInduced Pneumothorax Lumbar PunctureLumbar Puncture Myelogram Myelogram Nephrostomy Tube InsertionNephrostomy Tube Insertion Peg Feeding TubePeg Feeding Tube Peritoneal DialysisPeritoneal Dialysis PheresisPheresis PhototherapyPhototherapy RadiotherapyRadiotherapy Swan-Ganz InsertionSwan-Ganz Insertion TPA TPA Vaccination and ImmunizationsVaccination and Immunizations Venous CutdownVenous Cutdown

Emergency SituationEmergency Situation

The only time a consent might The only time a consent might notnot be obtained is an be obtained is an emergency emergency situationsituation

Emergency SituationEmergency Situation

The person must be in immediate The person must be in immediate need of medical attention. need of medical attention.

An attempt to secure consent An attempt to secure consent would result in delay of treatment would result in delay of treatment which would increase the risk to the which would increase the risk to the person’s life or health. person’s life or health.

(The emergency must be clearly (The emergency must be clearly documented by the physician in the documented by the physician in the medical record. Where practical, a medical record. Where practical, a second medical opinion indicating second medical opinion indicating the situation is an emergency, the situation is an emergency, should also be documented.)should also be documented.)

The Authorization for Medical The Authorization for Medical and/or Surgical Treatmentand/or Surgical Treatment

May be May be completed prior completed prior to the person’s to the person’s admission to the admission to the hospital. hospital.

(For example: (For example: By a secretary in By a secretary in the physician’s the physician’s office during a office during a pre-operative pre-operative visit.) visit.)

The Authorization for Medical The Authorization for Medical and/or Surgical Treatmentand/or Surgical Treatment

If written consent is If written consent is obtained in the obtained in the physician’s office, it is physician’s office, it is recommended that the recommended that the form be signed in form be signed in duplicate with one duplicate with one copy remaining in the copy remaining in the physician’s file and physician’s file and one copy mailed to the one copy mailed to the site access office.site access office.

Language ConsentsLanguage Consents

This This consent consent form is also form is also written in written in Spanish for Spanish for the Spanish the Spanish speaking speaking populationpopulation

How Long is a Consent Good For?How Long is a Consent Good For?

Consents will be considered Consents will be considered valid during the duration of a valid during the duration of a single admission except in single admission except in cases where significant cases where significant change in the patient’s change in the patient’s physical or mental status physical or mental status occurs. Patient‘s who, for occurs. Patient‘s who, for whatever reason are whatever reason are readmitted, must sign the readmitted, must sign the appropriate new consent.appropriate new consent.


There are other types of consent forms There are other types of consent forms used at Kaleida Health. used at Kaleida Health.

If it is a consent form that is used routinely If it is a consent form that is used routinely on your particular nursing unit, you will be on your particular nursing unit, you will be instructed how to obtain the consent instructed how to obtain the consent during your clinical orientation. during your clinical orientation.

If you are asked to get a type of consent If you are asked to get a type of consent that you are unfamiliar with, make sure that you are unfamiliar with, make sure that you have been instructed on the that you have been instructed on the proper procedure prior to obtaining it.proper procedure prior to obtaining it.


In situations where you In situations where you have unanswered have unanswered questions/concerns questions/concerns regarding obtaining regarding obtaining consent, you should consent, you should refer these refer these questions/concerns to questions/concerns to administration and/or administration and/or the risk manager for the risk manager for assistance.assistance.

CONSENTS Kaleida Health Education Department. The purpose of a written consent is to provide visible proof of consent. Purpose of a Consent.

Documents

consent slide

written consent

valid consent

informed consent explanation

visible proof of consent

physician explanation

kaleida health consent

contact risk management