I do hereby give full consent knowingly for any diagnostic, therapeutic, or operative procedure to be performed on me/my patient by the doctors, sisters, or any medical personnel of Charnock Hospital. I have been explained, in a language clearly understood by me, the procedures to be performed on me/my patient in my full conscious state. I fully understand the result/risk of such procedures, including any form of anaesthesia as deemed fit by the doctors in this hospital. I shall not hold the Hospital, Doctors and Staff responsible for any consequences arising in the course of such operations, administration of anaesthesia/drugs, or any investigation/treatment applied to myself/my patient. I agree to pay all bills as and when submitted for me/my patient's treatment and other charges.
I also agree to make the initial deposit and give my consent to the following:
- Any deposit required to be made as and when demanded on an interim basis, in addition to the initial deposit, will be adjusted in the final bill.
- Any amount of deposit short due to emergency admission will be paid within 12 hours of admission.
- Hospital will not be responsible for any loss of valuables belonging to the patient.
- The patient and the guardian shall be jointly and separately responsible for payment of all bills.
- I understand the language of the consent form and I shall be responsible for payment.
- I do hereby give my full consent to carry out tests for HIV, HBsAg, HCV by Charnock Hospital, and for Interventional or Surgical Procedures on me/my patient at Charnock Hospital.
- I understand that till the concerned consultant comes to see me/my patient, the Hospital doctors shall look after me/my patient.
- For all surgical operation packages, FULL ADVANCE DEPOSIT is mandatory.
- Only two relatives will be allowed to visit patients in the Hospital Ward per day during visiting hours, and only one relative will be allowed to visit in the ICU per day during visiting hours.
- We hereby give consent to Charnock Hospital authorities for taking a picture of my patient, considering "Patient Safety".