Cesarean section surgery and anesthesia consent form
The following is the consent form required for the patient's surgery. After listening to the explanation, if you have any questions, please be sure to ask the medical staff who will explain and fill out the form.
uPATIENT CONDITION / MEDICAL HISTORY
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Past Medical History |
o |
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Allergies |
o |
|
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Constitutional abnormalities |
o |
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Diabetes mellitus |
o |
|
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Hypertension/Hypotension |
o |
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Respiratory Disease |
o |
|
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Heart Disease |
o |
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Thyroid Disease |
o |
|
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Liver Disease |
o |
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Bleeding Tendency |
o |
|
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Kidney Disease |
o |
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Smoking |
o |
|
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Cerebrovascular disease |
o |
|
CurrentMedications |
o |
|
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Drug Side Effects |
o |
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Other |
o |
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◈ Cesarean section surgery
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Description
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1.Needfor surgery
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The purpose of the surgery is to ensure the safe delivery of the baby and to maintain the mother's health. |
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2. Surgical method and procedure
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