Below you will find an entire hospital consent form.    It is generally used in the registration process of admitting a patient to the hospital.  The form has many items listed on it mainly for the legal protection and financial benefit of the hospital.  Many patients will just sign it, unread.  Everyone should take the time to read these forms and mark off or correct any items you don’t agree with as this will serve as your record too.  Make sure if there is more than one page and the signature is on a different page that you make the correction/deletion on, that you note it on the signature line.  There have been instances where a correction was made but because it was on a different page, the corrected page somehow disappeared and an unaltered page appeared in its place.

The first consent form to study is the general one used by hospitals when admitting patients to in-hospital care.  This can be done during the registration process or if admitted by emergency, later in the patient room by a registrar.  Consent forms can be done in paper or electronic form but if there is an electronic version offered, you have the right to ask for a paper version.  If you ask for a paper version and you make corrections to or mark off areas you want to opt out of, please make sure to somehow note there are corrections on both forms.  In other words, don’t correct and sign the paper form without noting on the electronic form there are corrections.   This is important because some healthcare providers do not believe patients have the right to mark off areas of disagreement like no sales representatives present.  If the electronic version does not note this correction, the paper copy may never be added to your medical record.  I have discovered that electronic versions generally do not allow for corrections to be made.  In order to note corrections, the only place on many of them to note corrections is in the signature line.  My husband has crammed into the signature line all the corrections he requires like no sales reps, no medical students, no video/photographs, etc. along with his signature.  He also requests a copy of it along with taking a picture of it with his cell phone.  He learned the hard way that consent forms can be manipulated by the medical community to suit their purposes.  We have had medical staff saying there is no paper version which is untrue.  Some have said there is one hanging on a wall somewhere if you have to read it.  Don’t allow them to bully you into signing an electronic form without the benefit of a paper form and don’t allow them to tell you cannot add corrections to the electronic form in the signature area.

In the following paragraphs, the standard hospital consent form will be broken down in sections in order to highlight the meanings of each area.  Sadly, most of these forms are not read by the patient.  Sometimes a registrar will mislead a patient into saying the form is merely used for billing purposes like was done with this form but you can see in encompasses more than just billing. 

This form was brought to my husband while he was still sedated but in a patient room after the medical assault.  The female registrar told him he needed to sign it as it was for insurance purposes only.  Since he was under the influence of sedation, he complied as one of the properties of the sedation they used, versed, as it makes patient’s submissive/compliant.  He believed he had signed only for Medicare to pay for the hospital bill.  The registrar told an outright lie.  My husband signed it without reading it (he did not even have his reading glasses).  If he had been mentally capable thus knowing what it was, he would have made his usual corrections to the consent form.  It is so easy for them to deceive patients who are elderly, sedated or trusting that the medical system would never harm them.

Item #1 is a blanket consent that allows them to do really anything to the patient by anyone on their staff.  Notice the word “all” is used and it is defined as the hospital, its agents and employees, members of the medical staff, their agents and employees, and other healthcare practitioners who provide care to patients within the hospital, such as medical students and psychologist.  Notice that “all healthcare providers” is not defined in Item #1 but in the paragraph above it.  If you had skipped straight to the numbered items which they assume many will, you would have missed that medical students and psychologists (some in form of social workers) could be providing care to you.  This would have normally been where my husband would have listed that he would not consent to any medical students, trainees, or psychologists (social workers) to be part of his care.  This is would also be the area where he would now stipulate he requires same gender care because of prior medical sexual assault.  Many hospitals employ hospitalists to care for in-hospital patients while at the same time many will use Physician Assistants (PAs) or Nurse Practitioners (NPs) to provide patient care in place of a MD.  As it is the habit of some medical providers to wear their badges so they cannot be identified (they believe have a right to privacy in withholding their name from patients), many patients never realize they are not being seen by a MD.  In my husband’s case, the hospitalist’s name was written on the board but yet he never saw him. 

Item #2 is the consent for photographs/video for procedural/surgical events.  This will also show up again in the actual procedural consent form.  What many patients do not know and hospitals will not acknowledge is throughout most hospitals there are cameras.  Many procedures/surgeries are filmed for roundtable discussions, training purposes or for conferences.  Hospitals will not acknowledge this as they do not want patients to have copies of these videos for several reasons.  One reason is they do not want patients to see/know what happens to them during the procedure/surgery.  Another reason is they don’t want them used as evidence in malpractice proceedings.  The reason that really blows my mind is they say their filming of your naked and vulnerable body violates their staff’s right to privacy.  What are they doing or saying while you are naked that violates their rights?  Doesn’t the fact they film and have sole possession of it violate your right to privacy?

Item #3 is a fuzzy area because your medical records may be released for their convenience rather than for just the necessity of paying the bill(s).  You do have a right to limit who sees your medical records so check only the federal law but also your state’s individual laws governing medical records.  Generally there is an option to “opt-out” of the sharing of them.

Item #4 talks about the independent status of some medical providers meaning you could receive a separate bill from them.  They do this because they know there is no way you as a patient can or probably would check with every provider you have contact with to find out if they will be billing you separately from the hospital.  This covers the hospital’s responsibility and lies payment squarely on you.  This is the area that allows so many of the surprise and excessive bills that patients receive.  For example, the hospital will charge you to draw blood but you will also get a bill for the labbing of the blood.

Item #5 does the same as you, the patient, will have no idea who at the hospital who said they accept your insurance is actually not part of your insurance’s covered providers.  Although there is legislation covering this, I have yet to hear if it is truly protecting patients from surprise bills from out-of-network providers.  To me, it would seem that ethically if a hospital is part of your insurance plan, it is their responsibility to make sure those who they allow staff privileges to would also accept the same insurance plans. 

Item #6 puts the responsibility of pre-certification squarely on the shoulders of the patient.  Some hospitals may say they will pre-certify but I would advise you also find out if this is true.

Item #7 is pretty standard in all forms.  Just be aware this makes you solely responsible for any amount not paid by insurance and if you fail to pay, you are agreeing to their costs of recovering payment including their use of their legal team to do so.

Item #8 gives the hospital access to all methods of contacting you.  What it does not say is it may have your work number/email and could contact you for bill collection or even to sell you medical items.  As part of doing business, hospitals can use your contact info to sell to outside health-related sources to solicit you for products deemed related to your care.  If your diagnosis is inaccurate or intentionally falsified, this will furthermore follow you around.   We now have developed our own methods to avoid this situation.

Item #9 makes them not responsible if any of your belongings such as cell phone is stolen or they misplace your clothing.  Thief is quite common in hospital settings and yes, hospital staff are sometimes thieves as well as other patients and/or their families.

Item #10 is pretty standard.  You have the right to have your name listed in the patient directory or not.

Item #11 combines a lot of information into one.  Notice of Privacy is a huge one.  Read this carefully.  Some may say that by signing it does not mean you agree with it but does it really?  Ask for a copy of their Privacy Practices.  If there is an item you don’t agree with, then cross it off/highlight it and fill in your concern.  Sometimes you have to do this in the signature area due to lack of space.  Remember the questions you ask verbally and receive verbal information from is not really binding.  Sometimes you are not told the truth and sometimes their stories change.  Get it in writing or if your state allows for it, record these conversations.  As far as Advanced Directives, make sure if you have one, it is presented.  Don’t sign a new one unless you are in agreement as the old one becomes void.  I will in another post show the very Advanced Directive we prepared.  Most hospitals have a Patient Bill of Rights.  I will be posting some examples of them.  Read them.  Ask them for definitions of areas.  Advise them what certain areas mean to you.  Again, this conversation should be recorded.  Smoking Cessation is pretty standard.  Wonder why they don’t give standard information on alcohol abuse, overeating, drug abuse, lack of sleep, etc.? 

Item #12 tells you that any issues with care will be adjudicated in the state where the care was given and subject to the laws of that state.

Item #13 is only relevant if you are a Medicare client.  In back of hospital from hell’s patient book, is the information on Medicare rights and contact information for Medicare. 

Item #14 is pointless because most of the time, you are so upset, drugged, or just overwhelmed that you do not ask questions.  They count on this.  Again, verbal answers to questions mean nothing.

While this is a consent form from a central Indiana hospital, most of them are going to be similar. The important things to remember is to make corrections where needed. Get copies of those corrections either by having them make a copy or taking a picture with your cell phone. If you do not understand something, ask for an explanation and this is why if your state allows it, it is advisable to secretly record this interaction.

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