Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 7 - TEXAS MEDICAL DISCLOSURE PANEL
Chapter 604 - DISCLOSURE FORMS
Section 604.1 - Disclosure and Consent Form

Universal Citation: 25 TX Admin Code ยง 604.1

Current through Reg. 49, No. 38; September 20, 2024

(a) The Texas Medical Disclosure Panel adopts the following form which shall be used by a physician or health care provider to inform a patient or person authorized to consent for the patient of the possible risks and hazards involved in the medical treatments and surgical procedures named in the form. Except for the procedures shown in subsection (b) of this section, the following form shall be used for the medical treatments and surgical procedures described in Chapter 602 of this title (relating to Procedures Requiring Full Disclosure of Specific Risks and Hazards--List A). Providers shall have the form available in both English and Spanish language versions. Both versions are available from the Health and Human Services Commission.

(1) English form.

Attached Graphic

(2) Spanish form.

Attached Graphic

(b) Informed consent for:

(1) radiation therapy shall be provided in accordance with § 604.2 of this chapter (relating to Disclosure and Consent Form for Radiation Therapy);

(2) electroconvulsive therapy shall be provided in accordance with § 604.3 of this chapter (relating to Informed Consent for Electroconvulsive Therapy);

(3) hysterectomy procedures shall be provided in accordance with § 604.4 of this chapter (relating to Disclosure and Consent Form for Hysterectomy); and

(4) anesthesia and/or perioperative pain management (analgesia) procedures shall be in accordance with § 604.5 of this chapter (relating to Disclosure and Consent Form for Anesthesia and/or Perioperative Pain Management (Analgesia)).

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