医疗知情同意书汇编.docx

医疗知情同意书汇编.docx

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医疗知情同意书汇编

医疗知情同意书汇编

唐山市人民医院

二0一0年八月

第一篇公共告知部分............................................................1

1、入院知情同意书..............................................................2

2、入院宣教....................................................................4

3、授权委托书..................................................................5

4、病危病重通知书..............................................................6

5、输血/血液制品治疗知情同意书.................................................7

6、使用自费药品和医用耗材知情同意书............................................8

7、拒绝或放弃医学治疗知情同意书................................................9

8、未愈患者自动出院或转院知情同意书...........................................10

9、劝阻住院患者外出知情同意书.................................................11

10、尸体解剖知情同意书........................................................12

第二篇临床分科部分...........................................................13

第一章普通外科...............................................................14

1、腹腔镜下结直肠手术知情同意书...............................................15

2、肠道手术知情同意书.........................................................17

3、结直肠手术知情同意书.......................................................19

4、脾切除手术知情同意书.......................................................21

5、胃十二指肠手术知情同意书...................................................23

6、阑尾炎手术知情同意书.......................................................25

7、乳腺手术知情同意书.........................................................27

8、腹膜后肿物手术知情同意书...................................................29

9、胆道系统手术知情同意书.....................................................31

10、腹腔镜胆囊切除手术知情同意书..............................................33

11、肝脏手术知情同意书........................................................35

12、胰腺癌手术知情同意书......................................................37

13、门脉高压症手术知情同意书..................................................39

14、疝手术知情同意书..........................................................41

第二章胸心外科...............................................................43

1、肺癌手术知情同意书.........................................................44

2、食管贲门癌手术知情同意书...................................................46

3、胸外科手术知情同意书.......................................................48

4、胸壁肿瘤手术知情同意书.....................................................50

5、纵膈肿瘤手术知情同意书.....................................................52

6、先心病手术知情同意书.......................................................54

7、风湿性心脏病手术知情同意书.................................................56

8、冠心病手术知情同意书.......................................................58

第三章耳鼻喉科...............................................................60

1、鼻内镜下鼻腔电凝止血手术知情同意书.........................................61

2、鼻内镜下鼻腔泪囊吻合手术知情同意书.........................................63

3、鼻内镜下鼻中隔偏曲矫正手术知情同意书.......................................65

4、鼻腔鼻窦恶性肿瘤切除手术知情同意书.........................................67

5、鼻腔鼻窦良性肿瘤切除手术知情同意书.........................................69

6、鼻腔鼻窦内翻性乳头状瘤切除手术知情同意书...................................71

7、鼻咽纤维血管瘤手术切除手术知情同意书.......................................73

8、扁桃体切除手术知情同意书...................................................75

9、颌下腺肿物手手术知情同意书.................................................77

10、喉/下咽恶性肿瘤联合根治手术知情同意书.....................................79

11、喉癌支撑喉镜下激光手术知情同意书..........................................81

12、甲状腺癌联合根治手术知情同意书............................................83

13、甲状腺良性肿瘤手术知情同意书..............................................85

14、颈部肿物切除手术知情同意书................................................87

15、颈段食管癌手术知情同意书..................................................89

16、慢性鼻窦炎鼻息肉手术知情同意书............................................91

17、慢性化脓性中耳炎手术知情同意书............................................93

18、霉菌性鼻窦炎窦内病变去除手术知情同意书....................................95

19、腮腺肿物手术知情同意书....................................................97

20、舌颌颈联合根治手术知情同意书..............................................99

21、声带息肉或病变切除手术知情同意书.........................................101

22、外鼻肿物切除手术知情同意书...............................................103

23、腺样体切除手术知情同意书.................................................105

24、咽旁间隙肿瘤手术知情同意书...............................................107

第四章泌尿外科..............................................................109

1、包皮环切手术知情同意书....................................................110

2、耻骨上前列腺切除手术知情同意书............................................112

3、睾丸根治性切除手术知情同意书..............................................114

4、睾丸扭转探查手术知情同意书手..............................................116

5、睾丸肿瘤腹膜后淋巴结清扫手术知情同意书....................................118

6、经阴道尿道中段无张力吊带悬吊手术知情同意书................................120

7、精索静脉高位结扎手术知情同意书............................................122

8、前列腺癌根治手术知情同意书................................................124

9、经尿道前列腺电切手术知情同意书............................................126

10、肾癌根治术知情同意书.....................................................128

11、肾囊肿开窗手术知情同意书.................................................130

12、肾上腺肿瘤切除手术知情同意书.............................................132

13、双侧睾丸切除手术知情同意书...............................................134

14、经尿道液电碎石手术知情同意书.............................................136

15、阴茎部分切除手术知情同意书...............................................138

16、阴茎癌根治手术知情同意书.................................................140

17、肾部分切除手术知情同意书.................................................142

18、髂腹股沟淋巴结清扫手术知情同意书.........................................144

19、腹腔镜肾上腺肿瘤切除手术知情同意书.......................................146

20、腹腔镜肾囊肿开窗手术知情同意书...........................................148

21、腹腔镜精索静脉高位结扎手术知情同意书.....................................150

22、腹腔镜肾部分切除手术知情同意书...........................................152

23、腹腔镜前列腺癌根治手术知情同意书.........................................154

24、腹腔镜根治性肾盂输尿管癌切除手术知情同意书...............................156

25、经尿道膀胱肿瘤电切手术知情同意书.........................................158

26、膀胱造瘘手术知情同意书...................................................160

27、膀胱阴道瘘手术知情同意书.................................................162

28、膀胱全切原位新膀胱重建手术知情同意书.....................................164

29、膀胱全切输尿管皮肤造口手术知情同意书.....................................166

30、膀胱全切回肠膀胱手术知情同意书...........................................168

31、经尿道膀胱颈电切手术知情同意书...........................................170

32、膀胱部分切除手术知情同意书...............................................172

第五章口腔科................................................................174

1、拔牙手术知情同意书........................................................175

2、牙周手术知情同意书........................................................177

3、口腔种植修复治疗知情同意书................................................179

4、面部肿物手术知情同意书....................................................181

5、颌下腺肿物手术知情同意书..................................................183

6、颊粘膜病变手术知情同意书..................................................185

7、颊癌手术知情同意书........................................................187

8、腮腺癌手术知情同意书......................................................189

9、上牙龈瘤手术知情同意书....................................................191

10、下牙龈瘤手术知情同意书...................................................193

11、上牙龈恶性肿物手术知情同意书.............................................195

12、下牙龈癌手术知情同意书...................................................197

13、上颌骨囊肿手术知情同意书.................................................199

14、下颌骨囊肿手术知情同意书.................................................201

15、上腭癌手术知情同意书.....................................................203

16、上颌骨恶性肿物手术知情同意书.............................................205

17、舌下腺囊肿手术知情同意书.................................................207

18、舌良性肿物手术知情同意书.................................................209

19、舌癌手术知情同意书.......................................................211

20、口底癌手术知情同意书.....................................................213

21、口咽癌手术知情同意书.....................................................215

22、上唇癌手术知情同意书.....................................................217

23、下唇癌手术知情同意书.....................................................219

24、神经鞘瘤手术知情同意书...................................................221

25、甲状舌管囊肿手术知情同意书...............................................223

26、颈淋巴结转移癌手术知情同意书.............................................225

27、唇裂手术知情同意书.......................................................227

28、腭裂手术知情同意书.......................................................229

第六章骨科..................................................................231

1、肱骨近端骨折（包括内骨定和肩关节置换）手术知情同意书......................232

2、肱骨干骨折切开复位固定手术知情同意书......................................234

3、肱骨远端骨折手术（内固定和肘关节置换）手术知情同意书......................236

4、桡骨远端骨折切开复位内固定手术知情同意书..................................238

5、股骨粗隆间骨折手术知情同意书..............................................240

6、股骨颈骨折空心钉内固定手术知情同意书......................................242

7、股骨干骨折手术知情同意书..................................................244

8、胫骨平台骨折切开复位固定手术知情同意书....................................246

9、踝关节骨折切开复位固定手术知情同意书.....................................248

10、脊柱压缩骨折经皮穿刺椎体后凸成形术手术知情同意书….......................250

11、内固定取出手术知情同意书…...............................................252

12、骨科有创检查和治疗知情同意书.............................................254

13、关节镜手术知情同意书.....................................................256

14、人工髋关节置换手术知情同意书.............................................258

15、人工髋关节翻修手术知情同意书…...........................................250

16、人工全膝关节置换手术知情同意书...........................................262

17、人工全膝关节翻修手术知情同意书...........................................264

18、脊髓造影手术知情同意书...................................................266

19、脊柱矫形手术知情同意书...................................................268

20、颈椎前路手术知情同意书...................................................270

21、颈椎后路手术知情同意书...................................................272

22、胸椎后路手术知情同意书...................................................274

23、腰椎后路手术知情同意书.