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Control Number: <br />401.06.03.070 <br />Version: <br />3.0 <br />Title: <br />Informed Consent <br />Page Number: <br />3 of 4 <br /> <br />• Establishing and monitoring applicable contract medical provider policy and <br />procedure to ensure that all elements of this SOP and NCCHC standard P-I-05 <br />are accomplished as required. <br />Table of Contents <br />General Requirements .............................................................................................................. 3 <br />1. Guidelines ........................................................................................................................... 3 <br />2. Compliance ......................................................................................................................... 4 <br />References ................................................................................................................................ 4 <br />GENERAL REQUIREMENTS <br />1. Guidelines <br />The contract medical provider is responsible for supplying and providing any forms indicated <br />in this section. <br />• The healthcare provider is obligated to provide information sufficient for an offender <br />to make an informed decision to consent to or refuse recommended healthc are <br />intervention. If the offender requests, a more detailed explanation must be provided <br />to include details of the recommended procedure or treatment, the viable <br />alternatives, and any material risks to the recommended procedure or treatment. If <br />an offender does not speak English or Spanish, a written interpretation or telephone <br />interpretation service must be provided in the language spoken. <br />• Prior to any invasive healthcare procedure that has major adverse health risks being <br />performed, written informed consent shall be obtained from the offender. The <br />process for informing and clarifying understanding of the procedure (e.g., face-to- <br />face contact, discussion of the alternative(s), associated risks, etc.) must be <br />documented in the healthcare record. In addition, all signed consents must be <br />witnessed by someone other than the attending practitioner. <br />• When an offender has a health condition that requires diagnostic evaluation or <br />prescribed treatment, the prescribing practitioner must discuss the following with the <br />offender: <br /> The procedure or treatment to be undertaken; <br /> Any alternative procedures or methods of treatment available; <br /> Any associated risks; and <br /> The prognosis (if the proposed treatment is not undertaken). All areas discussed <br />must be documented in the offender’s healthcare record. If the offender does not <br />speak English or Spanish, a written interpretation or telephone interpretation <br />service must be provided in the language spoken. <br />• The offender must be asked if further explanation of the recommended prescribed <br />treatment or diagnostic evaluation is required. If not, the recommended treatment or <br />evaluation is prescribed. <br />• The informed consent form will be completed and signed by the offender for the <br />following procedures: