Patient Informed Consent Form Template for New Zealand

A comprehensive legal document designed for use in New Zealand healthcare settings that facilitates informed consent between healthcare providers and patients. This document complies with the New Zealand Code of Health and Disability Services Consumers' Rights and related legislation, ensuring that patients receive full disclosure about proposed medical procedures, treatments, or interventions. It includes detailed information about risks, benefits, alternatives, and expected outcomes, while protecting both patient rights and healthcare provider obligations under New Zealand law.

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What is a Patient Informed Consent Form?

The Patient Informed Consent Form is a crucial document required in New Zealand healthcare settings before any significant medical procedure or treatment. It serves as both a legal record and a communication tool, ensuring that patients are fully informed about their medical care as required by the Health and Disability Commissioner Act 1994 and the Code of Health and Disability Services Consumers' Rights. This document must be completed prior to any non-emergency medical procedure, documenting that the patient understands and agrees to the proposed treatment, its risks, benefits, and alternatives. It also serves as evidence that the healthcare provider has fulfilled their legal obligation to obtain informed consent under New Zealand law.

What sections should be included in a Patient Informed Consent Form?

1. Patient Information: Patient's full name, date of birth, NHI number, and contact details

2. Healthcare Provider Details: Name, registration number, and contact information of the healthcare provider/facility

3. Procedure Information: Detailed description of the proposed medical procedure, treatment, or intervention

4. Risks and Benefits: Clear explanation of potential risks, complications, and expected benefits of the procedure

5. Alternative Options: Description of alternative treatments available and consequences of non-treatment

6. Recovery and Aftercare: Expected recovery process, follow-up care requirements, and post-procedure instructions

7. Cost Information: Overview of costs, insurance coverage, and payment responsibilities

8. Declaration and Signatures: Formal consent statements, patient/guardian signature section, date, and witness details

What sections are optional to include in a Patient Informed Consent Form?

1. Interpreter Declaration: Required when information has been provided through an interpreter, including interpreter details and confirmation

2. Cultural Considerations: Specific cultural requirements or considerations relevant to the procedure or patient care

3. Research Participation: Additional consent for participation in research or teaching activities

4. Photography Consent: Permission for medical photography or recording during the procedure

5. Blood Products: Specific consent for use of blood products, required for procedures involving potential blood transfusions

6. Emergency Contact: Details of emergency contacts and their relationship to the patient

7. Advance Directive: Reference to any existing advance directives or living wills

What schedules should be included in a Patient Informed Consent Form?

1. Procedure Information Sheet: Detailed technical information about the specific procedure

2. Medication Information: Details of required medications, potential side effects, and interactions

3. Post-Procedure Care Guide: Comprehensive instructions for post-procedure care and recovery

4. Risk Statistics: Statistical information about procedure risks and success rates

5. Anatomical Diagrams: Visual representations of the procedure area and intervention

6. Patient Rights Summary: Summary of patient rights under NZ law and institutional policies

Authors

Alex Denne

Head of Growth (Open Source Law) @ Genie AI | 3 x UCL-Certified in Contract Law & Drafting | 4+ Years Managing 1M+ Legal Documents | Serial Founder & Legal AI Author

Cost

Free to use

Relevant legal definitions

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Healthcare

Medical Services

Allied Health

Dental Services

Mental Health Services

Aged Care

Disability Services

Private Hospitals

Public Hospitals

Research Institutions

Clinical Trials

Surgical Centers

Primary Healthcare

Specialist Medical Services

Relevant Teams

Legal

Clinical Operations

Patient Administration

Quality Assurance

Risk Management

Medical Records

Compliance

Patient Services

Clinical Research

Healthcare Operations

Relevant Roles

Medical Doctor

Surgeon

Nurse Practitioner

Registered Nurse

Dentist

Specialist Physician

Clinical Director

Healthcare Administrator

Medical Records Manager

Risk Management Officer

Legal Compliance Officer

Patient Services Manager

Quality Assurance Manager

Clinical Research Coordinator

Practice Manager

Medical Secretary

Healthcare Facility Manager

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What is a Patient Informed Consent Form?

What sections should be included in a Patient Informed Consent Form?

What sections are optional to include in a Patient Informed Consent Form?

What schedules should be included in a Patient Informed Consent Form?

Authors

Alex Denne

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