The purpose of this document is to provide written information regarding the risks, benefits and alternatives of transfusion of blood or primary components of blood (including, without …

This document gives you information about the risks, benefits, and alternatives to getting a blood transfusion to treat your condition. If you have any questions about any part of this document, …

Risks of transfusion that are specific to the patient (eg, risk of transfusion-associated circulatory overload in a patient with existing congestive heart failure) should be captured in the notes in …

FORM B-3 ITo be used for patients receiving transfusion(s) as their medical treatment, which is not part of an invasive diagnostic, medical or surgical procedure.

This consent form is to be used for blood product transfusions that are performed independent of a surgical procedure. Consent for blood product transfusion as part of a procedure should be …

I, the undersigned patient (or legal representative), have read and understood the information provided in this consent form, including the nature of the blood transfusion, associated risks, …

During each transfusion, I will be monitored for signs and symptoms of a possible reaction. The blood utilized is tested for various viruses, including HIV, Hepatitis B, and Hepatitis C. Only …

Dr. _____________________________________________________________ at this healthcare facility, has informed me that I need or may need transfusion of blood and/or one of …

TRANSFUSION OF BLOOD OR BLOOD PRODUCTS Page 1 of 3 on of blood or blood products by my doctor. Others, such as resident physicians, physician assistants, and registered nurses …

Jun 21, 2013 · I refuse the transfusion of blood and/or blood products and understand that I will be asked to sign a separate form entitled, Release from Liability for Refusal of Blood Transfusion.