Consent Forms




Consent Forms

 

Admission
Hospital Admission Application

Anesthesiology
ANESTHESIA

Cancer
Insertion of Central Vein Catheter
CHEMOTHERAPY
RADIOTHERAPY

Cardiology
ELECTROPHYSIOLOGICAL STUDY (EPS) AND RADIO FREQUENCY (RF) ABLATION
ELECTRICAL CARDIOVERSION
ICD (IMPLANTABLE CARDIOVERTER DEFRIBRILLATOR) IMPLANTATION
PACEMAKER IMPLANTATION
CARDIAC CATHETERIZATION


 Cardiothoracic Surgery

OPEN HEART SURGERY

Gastroenterology
GASTROINTESTINAL ENDOSCOPY

ERCP – ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY – PEG
DILATATION OF ESOPHAGUS

General
FINE NEEDLE ASPIRATION/NEEDLE BIOPSY/ CORE NEEDLE BIOPSY

Gynecology
EPIDURAL ANESTHESIA
CHORIONIC VILLUS BIOPSY (CVS)/PLACENTAL BIOPSY
EXTERNAL CEPHALIC VERSION (ECV)
REQUEST AND CONSENT FORM: INSERTION OF IUD
FETAL REDUCTION
CORDOCENTESIS
PUNCTURE AND ASPIRATION OF SPERM CELLS FROM TESTICLE AND/OR TESTICULAR SAC AND/OR BY TESTICULAR SURGERY
AMNIOCENTESIS
ARTIFICIAL INSEMINATION – COUPLE

ARTIFICIAL INSEMINATION DONOR – MARRIED COUPLE
ARTIFICIAL INSEMINATION DONOR – SINGLE WOMAN
HYSTEROSCOPY
FETAL ULTRASOUND EXAMINATION
NUCHAL TRANSLUCENCY
SELECTIVE TERMINATION OF PREGNANCY
VACUUM/CURETTAGE OF UTERUS FOR TERMINATION OF PREGNANCY (D & C)
TERMINATION OF PREGNANCY BY MEDICATION
IN-VITRO FERTILIZATION USING OVA DONATION
INDUCTION OF LABOR BY PGE2
IN-VITRO FERTILIZATION (IVF)
TUBAL LIGATION
CESAREAN SECTION
Laparoscopic Procedure in Gynecology
NUMBER OF EMBRYOS IMPLANTED IN MOTHER
HYSTERECTOMY WITH/WITHOUT SALPINGO-OOPHORECTOMY
HYSTEROGRAPHY
UTERINE FIBROID EMBOLIZATION

Nephrology
PERITONEAL DIALYSIS
HEMODIALYSIS

Neurosurgery
INTERNAL CAROTID ENDARTERECTOMY OR BYPASS
EXTRACRANIAL VENTRICULAR SHUNT
DRAINAGE OF CHRONIC SUBDURAL HEMATOMA
REVISION OF EXTRACRANIAL VENTRICULAR SHUNT
HYPOPHYSEAL AND SPHENOID SINUS SURGERY USING TRANS-SPHENOIDAL APPROACH

Ophthalmology
PTERYGIUM REMOVAL
CATARACT EXTRACTION
REPAIR OF RETINAL DETACHMENT
VITRECTOMY WITH/WITHOUT REPAIR OF RETINAL DETACHMENT
PHOTOREFRACTIVE KERATECTOMY BY EXCIMER LASER (PRK)/LASER-ASSISTED KERATO MILEUSIS (LASIK)

OPERATIONS ON EXTRAOCULAR MUSCLES
TRABULECTOMY

Orthopedic Surgery
ARTHROSCOPY OF THE KNEE
LUMBAR DISCECTOMY
LIMB LENGTHENING PROCEDURE
Total Hip/Knee Replacement
REPAIR OF RECURRENT DISLOCATION OF SHOULDER
RELEASE OF CARPAL TUNNEL SYNDROME (CTS) RELEASE OF ULNAR NERVE – GUYON’S CANAL
CORRECTION OF SPASTIC LIMB
CORRECTION OF DEVELOPMENTAL DYSPLASIA OF THE HIP (DDH)
CORRECTION OF CLUB FOOT
SURGICAL CORRECTION OF LEG-CALF-PERTHES
CORRECTIVE OSTEOTOMY OF LONG BONES

Otoloryngology
ADENOIDECTOMY/TONSILLECTOMY

Plastic Surgery
BOTULINUM TOXIN INJECTION FOR WRINKLES
REMOVAL OF CUTANEOUS LESION
RHINOPLASTY
MASTOPEXY
BREAST AUGMENTATION WITH BREAST IMPLANT
BREAST REDUCTION
RECONSTRUCTION OF BREAST
MOHS MICROGRAPHIC SURGERY
FACELIFT
BLEPHORAPLASTY
OTOPLASTY
LIPOSUCTION

Surgery
REPAIR OF ANAL FISSURE
LAPAROSCOPIC CHOLECYSTECTOMY
EXCISION OF GANGLION
THORACOSCOPIC UPPER DORSAL SYMATHECTOMY FOR PALMAR HYPERHYDROSIS
ORCHIOPEXY (UNDESCENDED TESTIS)
ORCHIOPEXY (ABDOMINAL TESTIS)
CONSENT FORM: THYROIDECTOMY (LOBECTOMY/PARTIAL/TOTAL)
APPENDECTOMY
OPERATION FOR RELEASE OF TRIGGER FINGER
REPAIR OF UMBILICAL HERNIA
OPEN REPAIR OF INGUINAL HERNIA
REPAIR OF FLEXOR/EXTENSOR TENDONS
EXPLORATORY LAPAROTOMY

Urology
URETEROSCOPY
CYSTOSCOPY
KIDNEY BIOPSY/FINE NEEDLE ASPIRATION
PERCUTANEOUS NEPHROLITHOTOMY (PCNL)
IMPLANTATION OF PENILE PROSTHESIS
PROSTATECTOMY FOR BENIGN HYPERPLASIA
STRESS INCONTINENCE

Vascular Surgery
SCLEROTHERAPY
OPERATION FOR VARICOSE VEINS OF THE LEGS
ANGIOGRAPHY
LOWER EXTREMITIES ENDARTERECTOMY/ARTERIAL BYPASS
ENDOVASCULAR REPAIR OF AORTIC ANEURYSM BY STENT

Beilinson Hospital: 39 Jabotinski St. | Petah Tikva | Tel: 03-9377377
Hasharon Hospital: 7 Keren Kayemet St. | Petah Tikva | Tel: 03-9372372