The Intubation Consent Form is a vital medical-legal document used in New Zealand healthcare settings to obtain and document informed consent for intubation procedures. It is designed in accordance with the Health and Disability Commissioner Act 1994 and related legislation, ensuring compliance with New Zealand's strict patient rights and medical consent requirements. The form is essential in both planned and emergency medical scenarios, providing comprehensive information about the procedure, risks, and alternatives while documenting the patient's (or their representative's) informed consent. It includes specific provisions for various scenarios including emergency situations, patients lacking capacity, and cases requiring cultural considerations or interpreter services. The document serves as both a legal record of consent and an educational tool for patients, reflecting the principles of informed consent central to New Zealand healthcare practice.
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1. Patient Information: Patient's full name, date of birth, NHI number, and contact details
2. Healthcare Provider Information: Name, designation, and contact information of the primary healthcare provider performing the intubation
3. Procedure Description: Clear, plain-language explanation of what intubation involves and why it is being recommended
4. Risks and Benefits: Detailed listing of common and serious risks associated with intubation, along with expected benefits
5. Alternative Options: Description of alternative treatments or consequences of not proceeding with intubation
6. Patient Acknowledgment: Confirmation that the patient has received and understood all information and had opportunity to ask questions
7. Consent Declaration: Formal statement of consent, including patient signature, date, and time
8. Healthcare Provider Declaration: Confirmation that procedure has been explained and questions answered, with provider signature
1. Interpreter Declaration: Section for interpreter details and confirmation when consent discussions require language assistance
2. Emergency Consent: Modified consent section for emergency situations where standard consent process may not be possible
3. Substitute Decision-Maker: Additional section when patient lacks capacity, including legal authority verification
4. Withdrawal of Consent: Section explaining the right to withdraw consent and process for doing so
5. Cultural Considerations: Space for documenting specific cultural requirements or considerations
6. Photography Consent: Optional consent for clinical photography or video recording of the procedure for medical records/teaching
1. Procedure Information Sheet: Detailed information about intubation procedure, preparation, and aftercare
2. Risk Documentation: Comprehensive list of potential complications and their likelihood
3. Post-Procedure Care Guide: Instructions for care and monitoring after intubation
4. Emergency Contacts: List of emergency contact numbers and when to seek urgent medical attention
5. Patient Rights Summary: Summary of relevant patient rights under the Code of Health and Disability Services Consumers' Rights
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