Get Medical Profile Form

To achieve truly informed consent, four criteria have been identified: Information disclosure. Competence. Comprehension. Voluntariness.

I (patient name) give permission for [practice name] to give me medical treatment. I allow [practice name] to file for insurance benefits to pay for the care I receive. I understand that: [practice name] will have to send my medical record information to my insurance company.

The informed consent documentation should be friendly, straightforward, and conversational. Ideally, the adult informed consent documents should be written at or below an 8th grade reading level, with a readability score of more than 50 (the higher the score, the easier your document is to read).

I have read and I understand the provided information and have had the opportunity to ask questions. I understand that my participation is voluntary and that I am free to withdraw at any time, without giving a reason and without cost. I understand that I will be given a copy of this consent form.

Considerations in preparing the informed consent document: Elements of consent present. Complete explanations. Lay language. Protection of confidentiality. No unproven claims of effectiveness. Device studies include a statement that the study includes an evaluation of the safety of the test article.

If you prefer to write your own consent document, you may do so, but be sure to include all required elements of informed consent.

I understand that my participation is voluntary and that I am free to withdraw at any time, without giving a reason and without cost. I understand that I will be given a copy of this consent form. I voluntarily agree to take part in this study.

Drafting tips for preparing consent forms: If possible, keep words to 3 syllables or fewer. Write short, simple, and direct sentences. Divide sentences into two when necessary. Keep paragraphs short and limited to one idea.