|
|
 |
 |
 |
|
|
|||
|
||||
|
||||
Birthing ball consent - Honest!(Long)From: RModugno@aol.comThu Jun 17 18:43:27 2004
Yes folks, here's the informed consent of the week! Robert Modugno MD MBA FACOG Marietta, GA Release for use of birthing ball: I have requested to use a birthing ball while in labor at______Hospital. I understand that I may bring a birthing ball me to the Hospital or may purchase one from the Hospital during this admission. I understand that I must take the ball with me when I leave the Hospital. The Hospital cannot arrange for disposal or reuse of the ball. I have received education regarding use of the birthing ball from the individual named below. I understand that there are risks associated with the use of the ball which could cause injury to me and/or my unborn child. These risks include, but are not limited to, loss of balance and falls, fatigue, infection, and aggravation of prior injuries. I understand that use of the birthing ball at _________Hospital must be approved by my physician or certified nurse midwife. I understand that I may not use the ball after I have received an epidural or if I am in preterm labor. I also understand that if I have had a prior injury or a history of arthritis, I must not use the ball without my physician's consent. I understand that my spouse, friend or family member must be with me at all times when I am using the ball to assist me in case I lose my balance. The Hospital has no duty to supervise me while I am using the ball. I understand that the balls provided by ___________Hospital are intended for use by patients between 5'2" and 5'10". I understand that if I am not within that height range I should not use the ball. In consideration for permitting me to use the birthing ball while a patient at _________Hospital, I release ________Hospital, my physician, certified nurse midwife, and their agents and employees from any and all claims, damages, responsibilities, and liabilities, which may arise, directly or indirectly, from or in connection with the use of the birthing ball. My spouse, friend or family member has also signed to indicate agreement with the above and understands that I must be supervised at all times. Patient Signature Witness Spouse/Significant other Date/Time Education provided by:____________________________ NOTE: Physician or nurse midwife order required for use of birthing ball Education provided by:____________________________
|
|
Return to
|
Mail a New Message to the Forum: ob-gyn-l@obgyn.net Forum Administrator: geffrey.klein@obgyn.net Report Technical Problems: webmaster@obgyn.net Last Updated: Thu Oct 2 04:46:13 2008 |
The American Medical Association is no longer designating CME hours for AMA Category II CME credit. However, physicians themselves may self designate learning activities as Category II CME credit hours if they feel it is of sufficient educational merit and meets the formal definitions of continuing medical education. OBGYN.net believes these interaction in this forum meets these criteria. For further information see the AMA web site.