表格2（Form 2）.docVIP

表格2（Form 2） Name of medical institution Informed consent for operation Name sex age division ward bed hospitalization record Preoperative diagnosis: The patient is suffering from the disease and needs surgical treatment. The doctor informed the patient of the current treatment options, alternatives, and explained the advantages and disadvantages. Informed by the patient, the patient agreed to select the treatment plan. Because of the individual difference in the condition of the disease, according to the conditions of the existing medical science and technology, the operation may be unforeseen or impossible to prevent adverse consequences and medical risks. The doctor has been fully to patients (patients with close relatives, and that the metasomatic agent), once the situation may worsen existing conditions, the emergence of new lesions (damage) and even endanger the life, medical staff will be according to the principle to be to try to rescue, but still may have adverse consequences. If you agree to the operation, please indicate in writing your wishes and sign. Surgeon signature: Signature of certified physician: I am a patient (agent) who has been treated in your hospital due to illness. After the doctor explained to me the advantages and disadvantages of the various treatment options, I chose surgical treatment. The doctor described above and on the back of this page is to inform the content of the example explanation and alternatives, I have fully understood, and willing to take the risk, agree with the above operation plan implementation and authorization according to the physician, physician judgment and patient benefit in the operation, adjust the operation program, and authorized physicians to reasonable treatment the removal of organs and tissues. As a matter of fact, I shall not object to any of these questions at the present and future. Signature of patient (agent): Signature of close relative of patient: Relationship with patients: I am a patient (agent