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L staff, including medical students and residents and fellows in training of the physician’s choice, to perform upon (patient’s name)_________________ an elective induction of labor and any other surgical or diagnostic procedures that may be required to complete the delivery of my baby. I have discussed the risks and benefits of this procedure with my physician. I accept the risks of the procedure as opposed to allowing labor to begin spontaneously at a later date. PLEASE INITIAL EACH PARAGR.

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