The Blood Draw Consent Form is a critical document used in Philippine healthcare settings prior to any blood collection procedure. This document is essential for compliance with the Philippine Medical Technology Act of 1991, the Data Privacy Act of 2012, and various Department of Health regulations governing medical procedures. It must be completed before any blood draw procedure, whether for diagnostic testing, research purposes, or medical treatment. The form includes vital information about the procedure, potential risks, patient rights, and data privacy provisions. It serves multiple purposes: documenting informed consent, protecting both patient and healthcare provider rights, ensuring compliance with medical-legal requirements, and providing clear information about the procedure and its purpose. The document is particularly important in the Philippine context, where strict regulations govern medical procedures and patient data protection.

1. Patient Information: Patient's full name, date of birth, address, contact information, and identification details

2. Purpose of Blood Draw: Clear explanation of why the blood draw is being performed and how the sample will be used

3. Procedure Description: Description of the blood draw procedure in simple, understandable terms

4. Risks and Potential Complications: List of common risks and potential complications associated with blood draws

5. Patient Rights: Statement of patient rights including the right to refuse or withdraw consent

6. Confidentiality Statement: Information about how patient data and test results will be protected and used

7. Healthcare Provider Information: Details of the healthcare facility and practitioner performing the procedure

8. Consent Declaration: Formal statement of consent with space for signatures

9. Authorization Signatures: Signature blocks for patient/guardian, healthcare provider, and witness