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1. Patient Information: Full legal name, ID number, date of birth, contact details, and medical aid information of the patient
2. Healthcare Provider Information: Details of the medical facility, treating physician(s), and relevant contact information
3. Nature of Treatment: Clear description of the proposed medical treatment, procedure, or intervention
4. Risks and Benefits: Detailed explanation of potential risks, benefits, and expected outcomes of the treatment
5. Alternative Treatments: Information about alternative treatment options and consequences of refusing treatment
6. Consent Declaration: Express statement of consent, confirming understanding and voluntary agreement to proceed
7. Signatures and Date: Space for patient/guardian signature, witness signature, and date of signing
1. Guardian Details: Required when patient is a minor or lacks capacity - includes guardian's full details and relationship to patient
2. Interpreter Confirmation: Required when consent discussions are conducted through an interpreter
3. Emergency Provisions: Required for treatments that may lead to emergency situations requiring additional interventions
4. Photography Consent: Optional section for consent to medical photography or recording if relevant to the treatment
5. Blood Product Consent: Required if blood transfusions might be necessary during treatment
6. Clinical Trial Information: Required if the treatment is part of a clinical trial or research study
1. Treatment Protocol: Detailed medical protocol or treatment plan attached as reference
2. Information Leaflet: Detailed information about the treatment, medication, or procedure
3. Pre/Post Treatment Instructions: Specific instructions for before and after the treatment
4. Cost Estimate: Breakdown of expected costs and medical aid coverage if applicable
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