Martin Memorial Health Systems Stuart, Florida
Order ID 53003233773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages
Martin Memorial Health Systems Stuart, Florida
SPECIAL PROCEDURE CONSENT FORM I have read, or have had read to me, and understand the following authorization for ______________________________________________________________________ ______________________________________________________________________ I authorize Dr. __________________________________ to perform the above described procedure or treatment. I have discussed my medical condition, the proposed treatment or procedure, alternatives to this treatment and the risks associated with them with my physician. I have been informed that in the performance of any invasive procedure, there is the potential for damage to my organs, nerves, and blood vessels, allergic reaction, blood clots, inadvertent puncture, laceration, infection, consequent hemorrhage, and very rarely death.
I fully understand that it may be necessary to proceed with additional procedures, or possibly surgery, to repair the injury or control and treat the complication. I specifically request my physician to proceed with whatever is deemed medically necessary and request that I be given a full explanation after the effects of sedation have subsided.
I agree to the administration of blood or blood products if they are required. (Potential risks of blood transfusions include the risk of hepatitis, AIDS, or other infections or reactions). I agree to the administration of contrast (IV dye) if required. (Potential risk of contrast reaction). I agree that any tissue or parts surgically removed may be disposed of in accordance with the hospital’s accustomed practice. I agree that my physician may permit photographs or video tapes of my procedure or treatment, employing appropriate privacy draping of my person, to record the procedure for the express purpose of medical education or to provide a record to be filed with strict confidence with my medical records. I have been informed that other practitioners may be performing important aspects of the procedure, administering anesthesia or implanting devices that are within their scope of practice.
I consent to the observation of my procedure or treatment by individuals for the purposes of medical education and to the presence of a medical representative in the operating/procedure room. I understand medical representative to mean non-medical technician of companies which have furnished operating room/procedural equipment and supplies. During this procedure I may receive MODERATE SEDATION which is a drug-induced depression of consciousness during which patients respond purposefully to verbal commands, either alone or accompanied by light tactile stimulation. No interventions are usually required to maintain a patent airway, and spontaneous ventilation is adequate. Cardiovascular function is usually maintained. The patient is usually very sedated, but may still be able to hear and respond to their medical providers and remembers some
or all of their experience. Side effects and complications of moderate sedation are relatively uncommon but can occur. While it is impossible to advise you of every conceivable complication, some possible examples are; • Progression to a deeper level of sedation.
Soreness of the throat and hoarseness are very common occurrences • Aspiration (inhaling stomach contents into the lungs), asthma attacks, and pneumonia. • Nerve injuries and possible weakness or paralysis. • Allergic-type reactions leading to cardiac arrest and death. • Nodules, polyps, or other damage to the vocal cords or windpipe. • Sometimes dreams during anesthesia are confused with recall of real events.
- Medical complications involving damage to the eyes, heart, lungs, and circulatory system such as corneal abrasions, blindness, stroke, blood clots, abnormal heart rhythms, phlebitis, collapsed lung, and heart attack. • Possible traumatic injury to the jaw which may include dislocation, arthritis, temporomandibular joint (TMJ) disorder or chronic pain. Teeth and dental prosthetics may become loose, broken, or dislodged, especially if loose or in poor repair regardless of the care provided by the provider. By signing this consent you are acknowledging that your providers and Martin Health System will not be liable for any dental damage or repairs. I have had the opportunity to have my questions answered to my satisfaction. I authorize my physicians and Martin Memorial to disclose health information related to this treatment or procedure to any friend or family member who has accompanied me or who is waiting for me, even if I am competent or available, with the exception of the following: ______________________________________________________________________ _____________________________________________ _________________ Patient/Authorized Surrogate or Proxy Signature Date/time _____________________________________________ _________________ Witness Signature Date/time I certify that I have explained the nature, purpose, benefits, risks, complications, and alternatives to the proposed procedure as well as the risks, benefits and alternatives of moderate sedation to the patient or the patient’s legal representative. I have answered all questions fully, and I believe that the patient / legal representative fully understand what I have explained. I further certify that I have validated the procedure/site and side and that the correct procedure site has been marked, if indicated, prior to the procedure being performed. The patient has been evaluated and is a candidate for moderate sedation. _____________________________________________ _________________ Practitioner Signature Date/time □ “Language Line” SM used to interpret consent form for patient.
MARTIN MEMORIAL HEALTH SYSTEMS STUART, FLORIDA
SPECIAL PROCEDURE CONSENT RM058 4/01, 7/07, 10/08, 1/10, 8/11, 5/13
REVISIONS MADE TO THIS CONSENT MUST BE APPROVED BY RISK MANAGEMEN
Martin Memorial Health Systems Stuart, Florida
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. They can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally, the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper.
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