Consent for Delivery of Wound Care

 I authorize ACUHEAL WOUND SPECIALISTS, his/her associates, and such other doctors or qualified medical persons as are needed to deliver wound care.

Procedures may include wound debridement (removing unhealthy or dead tissue) using sharp instruments, suturing, biopsy, or compression wraps to decrease edema (swelling).

Please enter a valid procedures.

 The doctor, nurse practitioner, and/or nurse have explained the nature of this procedure and how it is performed. I have been informed of the reason for this treatment, its alternatives, and the risks involved. I have been informed that possible untoward effects could include bleeding, pain, infection, or cardiac problems.

In addition to the above, I agree to the following (any exceptions must be noted in the box below):

Please enter a valid exceptions.

 I hereby certify that I have read and fully understand the above consent.

Name of Patient or person authorized to consent for the patient is required.
Please provide a valid date.
Name Witnessed By is required.
Please provide a valid date.
Patient Informed By name of staff is required.
Please provide a valid date.

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