Consent for Sterilization This Form Allows an Individual to Provide Consent for Sterilization Statements Are Also Included for a
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People also ask
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What is the PM330 consent form?
CONSENT FORM PM 330 State of California -- Health and Human Services Agency NOTICE Department of Health Services YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL NOT RESULT IN THE WITHDRAWAL OR WITHHOLDING OF ANY BENEFITS PROVIDED BY PROGRAMS OR PROJECTS RECEIVING FEDERAL FUNDS.
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Do I need my husband's consent for tubal ligation?
The consent of the spouse is not required even if it incidentally will result in the sterilization of the patient. Statutes in Georgia, North Carolina, and Virginia requie the written consent of the patient's spouse to voluntary sterilizations.
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What is informed consent for voluntary sterilization?
A copy of the sterilization consent must be given to the patient and a copy for the physician and hospital and attached to all claims for sterilization procedures. 30 days (but not more than 180 days) must pass after the sterilization consent form has been signed. The 30 days starts the day after the consent is signed.
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What consent is required for sterilization?
PHYSICIAN'S STATEMENT To the best of my knowledge and belief the individual to be sterilized is at least 21 years old and appears mentally competent. He/She knowingly and voluntarily requested to be sterilized and appeared to understand the nature and consequences of the procedure.
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What is the consent for sterilization form in SC?
The Consent for Sterilization - SCDHHS form 687, is required for ALL procedures intended to result in sterilization. The Consent for Sterilization - SCDHHS form 687, is NOT required when a Hysterectomy is to be performed and prior sterilization has occurred.
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How long is a PM330 good for?
My consent expires 180 days from the date of my signature below. Representatives of the Department of Health and Human Services.
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What is a PM330 consent form?
CONSENT FORM PM 330 State of California -- Health and Human Services Agency NOTICE Department of Health Services YOUR DECISION AT ANY TIME NOT TO BE STERILIZED WILL NOT RESULT IN THE WITHDRAWAL OR WITHHOLDING OF ANY BENEFITS PROVIDED BY PROGRAMS OR PROJECTS RECEIVING FEDERAL FUNDS.
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What is a consent form used for?
An informed consent document is typically used to provide subjects with the information they need to make a decision to volunteer for a research study. Federal regulations (45 CFR 46.116 ) provide the framework for the type of information (i.e., the "elements") that must be included as part of the consent process.
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