Washington State is starting to open up following our stay-at-home order. I am really looking forward to getting back to what I love – taking care of patients. We have worked very hard along with our national societies and governmental agencies to put in place procedures to keep ourpatients and ourselves as safe as possible. I am over 60 as are three of our four anesthesiologist and our nurse manager and you will find us here, doing our jobs. We would be foolish to pretend that there is no increased risk during these times.
We have put together the following informed consent form for patients during this time. Like all informed consent forms, it is meant not to frighten but to rather inform patients and remind them that surgery, even elective plastic surgery, is never risk free. All patients undergoing surgery during this pandemic will be given this form and be required to sign off on it. And remember, me and my staff are signing off on this increased risk every day we show up for work. Should you have questions about our protocols, don’t be afraid to ask!
COVID-19 RISK INFORMED CONSENT
I (patient name) understand that I am opting for an elective treatment/procedure/surgery that is not urgent and may not be medically necessary.
I also understand that the novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. I further understand that COVID-19 is extremely contagious and is believed to spread by person-to-person contact; and, as a result, federal and state health agencies recommend social distancing. I recognize that Dr. Shahram Salemy and Dr. Lisa Sowder and all the staff at Madison Tower Plastic Surgery and Madison Tower Surgery Center are closely monitoring this situation and have put in place reasonable preventative measures aimed to reduce the spread of COVID-19. However, given the nature of the virus, I understand there is an inherent risk of becoming infected with COVID-19 by virtue of proceeding with this elective treatment/procedure/surgery. I hereby acknowledge and assume the risk of becoming infected with COVID-19 through this elective treatment/procedure/surgery, and I give my express permission for Dr. Shahram Salemy and Dr. Lisa Sowder and all the staff at Madison Tower Plastic Surgery and Madison Tower Surgery Center to proceed with the same.
I understand that, even if I have been tested for COVID and received a negative test result, the tests in some cases may fail to detect the virus or I may have contracted COVID after the test. I understand that, if I have a COVID-19 infection, and even if I do not have any symptoms for the same, proceeding with this elective treatment/procedure/surgery can lead to a higher chance of complication and death.
I understand that possible exposure to COVID-19 before/during/after my treatment/procedure/surgery may result in the following: a positive COVID-19 diagnosis, extended quarantine/self-isolation, additional tests, hospitalization that may require medical therapy, Intensive Care treatment, possible need for intubation/ventilator support, short-term or long-term intubation, other potential complications, and the risk of death. In addition, after my elective treatment/procedure/surgery, I may need additional care that may require me to go to an emergency room or a hospital.
I understand that COVID-19 may cause additional risks, some or many of which may not currently be known at this time, in addition to the risks described herein, as well as those risks for the treatment/procedure/surgery itself.
I have been given the option to defer my treatment/procedure/surgery to a later date. However, I understand all the potential risks, including but not limited to the potential short-term and long-term complications related to COVID-19, and I would like to proceed with my desired treatment/procedure/surgery.
Thanks for reading and I would be grateful if you followed me on Instagram @sowdermd and @breastimplantsanity. Dr. Lisa Lynn Sowder