Disclosure and consent forms
Explore Medical City Healthcare's disclosure and consent forms page for important documents related to your healthcare journey in North Texas.
It is the policy of Medical City Dallas that all patients and/or other legal surrogate decision maker(s) have the right to be informed about, and participate in, decisions regarding their care.
Prior to the performance of a medical, diagnostic, or surgical procedure(s), the medical staff (physician, oral surgeon, anesthesiologist , or podiatrist) must provide informed consent in compliance with the Texas Health and Safety Code Chapter 313, Consent to Medical Treatment Act and any other regulatory bodies issuing guidelines for the consent process.
What surgical and therapeutic procedures require informed consent?
Medical, surgical, diagnostic and/or therapeutic procedures, hemodialysis, intravenous contrast administration, central line insertions, blood transfusion, all forms of anesthesia and/or invasive procedure(s).
Can a consent be obtained in advance within the physician's office?
Yes. Only the MCD-MCHS approved facility consent will be accepted and the consent must be fully executed- It must be signed, dated, and timed by the patient, witness and surgeon / proceduralist. If witnessed by the office staff, they must sign and print their name. Physician Practice created consents will not be accepted.
Who must sign the consent to assure it is fully compliant?
The physician performing the medical or surgical procedure, the patient and/or legal surrogate, and the witness(es). Each must Print their name, Sign their name and Date-Time.
Who can obtain the patient signature on a consent?
The physician must print their first and last name, sign, DATE and TIME the HCA Facility Consent with the appropriate Disclosure List (A-B) attached.
The patient signature should be obtained at the same time by either the physician or the physician’s office staff.
Communication Barriers: How do we assure the patient has been adequately informed of risks and hazards if we have identified a communication barrier such as language, hearing, or visual impairment?
Patients who meet the criteria for giving consent but have a communication barrier, (i.e., hearing impaired, unable to comprehend English, etc.) shall be provided with an interpreter or interpretation services free of charge.
Patients who are visually impaired/blind will have the information read to them in the presence of a witness, if requested. (Refer to process for Telephone/Verbal Consent)
When an interpreter is used to explain the form to the patient, the consent requires a witness signature and completion of the Authorization/Completion Code- name or ID of the interpreter and be documented on the consent.