Consent Forms
Welcome to OMIC’s Consent Form library, a collection of procedure-specific consent forms that you can modify to suit your practice and patient population. Contact riskmanagement@omic.com with questions.
Found
4
resources.
Oct 6, 2014
| Consent Form
Informed Consent for Ptosis (Droopy Eyelid) Surgery WHAT IS PTOSIS AND HOW IS IT CORRECTED? Ptosis is a condition that occurs when one or both upper eyelids droop and the edge of the upper eyelid falls over the pupil. Just like a curtain, the eyelid can block the view, especially...
Oct 9, 2014
| Consent Form
...of the eyelid) and/or punctal (tear hole) eversion can occur, despite optimal surgical technique. 6. Blepharoptosis – Blepharoptosis (drooping of the eyelid) can result from inadvertent injury to structures in the upper eyelid, especially in thin-skinned people. Please initial after reading this page ________________ PATIENT CONSENT If the complication happens...
Oct 6, 2014
| Consent Form
...Glaucoma (increased eye pressure) in injected/other eye that may be transient or permanent and could lead to medical or surgical treatment (i.e., excision of depot or glaucoma filtering operation). 5. Blepharoptosis. 6. Proptosis. 7. Orbital fat atrophy, fibrosis. 8. Delayed hypersensitivity reactions. 9. Strabismus. 10. Conjunctival hemorrhage. 11. Chemosis. 12....
Oct 3, 2014
| Consent Form
...the retina from the wall of the eye resulting in loss of vision · Stromal Melting- thinning or melting of the corneal transplant tissue that holds the keratoprosthesis in place, resulting in loosening or loss of the keratoprosthesis · Ptosis- a droopy eyelid · Loss of vision · Blindness ·...
These are sample forms—download, review and revise as needed.