原创力文档- 1、本文档共7页，可阅读全部内容。
- 2、原创力文档（book118）网站文档一经付费（服务费），不意味着购买了该文档的版权，仅供个人/单位学习、研究之用，不得用于商业用途，未经授权，严禁复制、发行、汇编、翻译或者网络传播等，侵权必究。
- 3、本站所有内容均由合作方或网友上传，本站不对文档的完整性、权威性及其观点立场正确性做任何保证或承诺！文档内容仅供研究参考，付费前请自行鉴别。如您付费，意味着您自己接受本站规则且自行承担风险，本站不退款、不进行额外附加服务；查看《如何避免下载的几个坑》。如果您已付费下载过本站文档，您可以点击 这里二次下载。
- 4、如文档侵犯商业秘密、侵犯著作权、侵犯人身权等，请点击“版权申诉”（推荐），也可以打举报电话：400-050-0827(电话支持时间：9:00-18:30)。
查看更多
Sample Patient InformationInformed Consent Form样本的患者informationinformed同意书
Sample Patient Information/Informed Consent Form
This information is provided to help you understand the treatment I am recommending for you. Before I begin treatment, I want to be certain that I have provided you with enough information in a way you can understand, so that you’re well informed and confident that you wish to proceed. This form will provide some of the information. I will also have a discussion with you.
PLEASE BE SURE TO ASK ANY QUESTIONS YOU WISH. It’s better to ask them now, than wonder about it after we start the treatment.
Nature of the Recommended Treatment:
I am recommending the following treatment(s) for you:
______________________________________________________________
I base this recommendation on the visual examination(s) I have performed, on any x rays, models, photos and other diagnostic tests I have taken, and on my knowledge of your medical and dental history. I have also taken into consideration any information you have given me about your needs and wants. The treatment is necessary because:
_______________________________________________________________
The benefits of this treatment are: ___________________________________
_______________________________________________________________
The prognosis, or chance of success, of the treatment
is:______________________________________________________________
I expect that it will take approximately ______________________to complete the treatment, but it could be shorter or longer based on what we experience as the treatment progresses. I expect it to cost about $ ______________and I will let you know as soon as possible if the cost estimate increases or if it can be reduced.
Alternative Treatments:
There are many ways to treat dental problems. I have chosen the one that I think best suits your needs. However, them are other ways that your condition can be treated, including:
______________________________________________________________
If you have any questions about these alter
文档评论（0）