Consent to honey

Informed voluntary consent to types of medical intervention

I, _______________________________________________________________________________ (mother, father, adoptive parent, guardian, trustee, legal representative, underline)

_____________________________________________________________________________________________________

(Name of the child)

I give informed voluntary consent to the types of medical interventions included in the List of certain types of medical interventions for which citizens give informed voluntary consent when choosing a doctor and a medical organization to receive primary health care, to receive primary health care / to receive primary health care. sanitary assistance by the person whose legal representative I am.

If necessary, in the event of an urgent situation, I agree to carry out:

• Anesthetic benefits;

Puncture of joints and intra-articular administration of drugs;

• Closed reduction in fractures;

• Gastric lavage;

• Cleansing and healing enema;

• Treatment of wounds and the imposition of bandages, sutures;

• Surgical treatment of purulent-necrotic processes;

• Provision of gynecological and urological care;

• Provision of drug addiction and psychiatric care, including inpatient care, in health care institutions licensed to provide medical care for these types of activities;

• Hospitalization for medical reasons in medical institutions outside the camp.

I also give my consent to the processing of the necessary personal data in the amount and in the ways specified in "On Personal Data".

The list of personal data for the processing of which the consent of the subject of personal data is given: last name, first name, patronymic, date and place of birth, address, contact phone number, details, data on health status, diseases, cases of seeking medical help, and other information. The list of actions with personal data for the performance of which consent is given: collection, systematization, accumulation, storage, clarification (update, change), use, distribution (including transfer) in the manner prescribed by law, depersonalization, blocking, destruction of personal data, other actions.

I, the parent (legal representative) of the child, have been explained the right to familiarize themselves with the goals, methods of providing medical care, associated risks, possible options for medical interventions, their consequences, including the likelihood of complications, the possibility of referring the child for treatment to a medical and prophylactic institution, as well as the expected results of medical care, which are on electronic pecsypcax.

Medical worker (position, full name of medical worker)

(To be completed in case of personal presence of the parent (legal representative) upon arrival of the child)

in a form accessible to me, the goals, methods of providing medical care, the associated risk, possible options for medical interventions, their consequences, including the likelihood of complications, the possibility of referring the child for treatment to a medical institution, as well as the expected results of medical care.

It has been explained to me that I have the right to refuse one or more types of medical interventions included in the List, or to demand its (their) termination.

I have read (read) and agree (agree) with all the points of this document, the provisions of which have been explained to me, I understand.

This consent is valid for the duration of my child's stay.

I reserve the right to revoke my consent by drawing up an appropriate written document, which can be sent by me to the administration by registered mail with acknowledgment of receipt, or delivered personally against receipt to a representative.

_________________ ___________________________________

Signature of the full name of the legal representative

_________________

the date