Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 7 - TEXAS MEDICAL DISCLOSURE PANEL
Chapter 604 - DISCLOSURE FORMS
Section 604.4 - Disclosure and Consent Form for Hysterectomy

Universal Citation: 25 TX Admin Code ยง 604.4

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

The Texas Medical Disclosure Panel adopts the following form which shall be used to provide informed consent to a patient or person authorized to consent for the patient of the possible risks and hazards involved in the hysterectomy surgical procedure named in the form. This form is to be used in lieu of the general disclosure and consent form adopted in § 604.1(a) of this chapter (relating to Disclosure and Consent Form) for disclosure and consent relating to only hysterectomy procedures. 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

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