Patient's chart. Ensure that all required forms are included, complete
as necessary, and in order dictated by local policy. Document compliance or insert
form(s) as necessary.
Place your initials in the box to indicate that the form is in the
chart and completed.
(b) If forms are missing or incomplete, notify the Charge Nurse or
physician as indicated.
Required forms are:
SF 515, Tissue Examination -- 2 copies.
SF 516, Operation Report -- 3 copies.
SF 517, Anesthesia -- 2 copies.
SF 518, Blood or Blood Component Transfusion -- 3 copies.
5 SF 522, Request for Administration of Anesthesia and for
Performance of Operations and Other Procedures (see Figure 1-7.) This is the legal
document that satisfies the requirement of informed consent.
a It must be signed by the physician and anesthesiologist
to indicate that all risks of surgery and anesthesia have been fully explained to the
b The preoperative patient must sign the form in the
presence of a witness to consent for a surgical procedure.
The witness must NOT be anyone on the surgical team.
The date and time that the patient signed must be
written on the form.
e Minors (patients under legal age) cannot sign for
themselves; it must be signed by a parent or legal guardian.
NOTE: Legal age is established on a state-by-state basis.
Legal consents must be signed PRIOR to the
form is not legally binding.