This is general surgery consent form in clinics of Korea.
They will need your sign of this consent just before surgery, so it would be better to read in previous.
The patient has the right to be informed about the current state of surgery or the anesthesia of the doctor in charge and this information will help the patient decide whether or not to undergo surgery for him or herself.
Patient’s name:________________________ / Gender: __________________ / Resident registration number:_________________________
I voluntarily ask the doctor in charge_________________ and medical personnel who are deemed necessary by the doctor in charge to treat my problem.
I understand that the following Techniques will be performed.
Article 1 (Possibility of complications related to surgery)
I understand that there may be risks due to planned techniques. I understand that after all commonly performed techniques, infection, bleeding, allergic reactions, thrombosis, and I admit that the following problems may arise in connection with particular techniques.
Lack of cosmetic and functional improvement
Article 2 (delegation of surgery method)
I fully understand that if a doctor in charge during surgery identifies a new problem or a problem that is different from the initial description, he can be performed in a different way than planned techniques, and this is done at the discretion of the doctor in charge, who is the expert in charge, so I delegate the authority of all techniques to the doctor in charge.
Article 3 (possibility of re-surgery)
Article 4 (Limitation of Surgery)
I understand that both sides of body may not be identical and can not be made identically.
I understand that if the doctor in charge used computer images during consultation, this way only for communication and that the general images are only ideal goal and may differ from actual surgical outcome.
Article 5 (Medical records and clinical photographs)
Article 6 (First Aid)
Article 7 (Anesthesia)
I have been fully heard from the doctor in charge about the current state, the nature and effects of surgery and anesthesia to be performed, the risks that may arise, and other treatment options, and I understand this, so I voluntarily agree the surgery.
I admit that this document were no obstacles to self-determination when consulting and agreeing the surgery.
I admit that this document has been fully explained to me and has not been falsified, and I hereby admit the validity of my signature or my legal representative’s signature.