INFORMED CONSENT AND CONTRACT WITH ANAESTHETIST
General Understanding
- I understand that a qualified anaesthetist will take responsibility for my peri-operative care.
- I understand that during the procedure, my physical condition and/or the surgical circumstances may change and may require adjustments to the anaesthetic management, and that such decisions will be made with my safety as the primary consideration.
- I understand that I have the option to refuse anaesthesia and that the risks, benefits, and alternatives have been explained to me.
- I understand that an incident-free anaesthetic and specific outcome cannot be guaranteed.
- I understand that anaesthetic equipment and certain support staff are supplied by the hospital, and although all equipment is routinely checked, its availability and function cannot be guaranteed by the anaesthetist.
- I understand that no guarantee can be given regarding my individual response to medications administered during the anaesthetic.
- I understand that this informed consent is valid only for the procedure to which I have agreed.
- I understand that I may withdraw my consent at any stage prior to the commencement of the anaesthetic.
Patient Responsibilities and Pre-Operative Requirements
- I confirm that I have been informed of the required fasting instructions and understand that failure to comply may result in cancellation of the procedure or increased anaesthetic risk, including the risk of aspiration.
- I confirm that I have disclosed all relevant medical history, medications, allergies, and substance use, and understand that failure to do so may increase anaesthetic risk.
- I understand that the planned anaesthetic technique, including sedation, may need to be changed to an alternative technique, including general anaesthesia, if clinically indicated.
- I consent to any additional or alternative anaesthetic procedures that may be considered necessary in my best interests during the course of treatment.
Risks of Anaesthesia
I understand that anaesthesia carries inherent risks.
Possible risks and complications include, but are not limited to, the following:
General Anaesthesia
- Sore throat and hoarseness.
- Injury to the airway, lips, or teeth.
- Nausea and vomiting.
- Aspiration of stomach contents.
- Pneumonia and other respiratory complications.
- Injury to nerves or blood vessels.
- Adverse or allergic drug reactions.
- Awareness during anaesthesia.
- Cardiovascular complications including arrhythmias, heart attack, or stroke.
- Blood clots including deep vein thrombosis or pulmonary embolism.
- Brain injury.
- Death (rare).
Regional Anaesthesia / Spinal / Epidural
- Risks similar to those listed above where applicable.
- Low blood pressure.
- Headache, including post-dural puncture headache.
- Discomfort or pain during the procedure.
- Incomplete or failed block requiring conversion to general anaesthesia.
- Temporary or, rarely, permanent weakness or loss of sensation.
- Nerve injury.
- Infection, including epidural abscess.
- Bleeding, including epidural haematoma.
- Urinary retention.
- Itching.
- Very rarely, serious neurological complications.
Sedation
- I understand that sedation may result in varying levels of consciousness.
- I understand that sedation carries risks including breathing difficulties, airway obstruction, and the need to convert to general anaesthesia.
Blood Products
- I consent to the administration of blood and/or blood products if deemed necessary.
- I understand that, although screened, such products carry small risks including infection or reaction.
Post-Operative Considerations
- I understand that I may experience drowsiness, impaired judgement, or reduced coordination following anaesthesia.
- I undertake not to drive, operate machinery, or make important decisions for at least 24 hours after the procedure.
- I understand that I must be accompanied by a responsible adult after the procedure and that failure to comply may result in cancellation of the procedure.
Financial Responsibility and Billing
- I understand that the anaesthetic account is separate from the hospital and surgeon accounts and that I, as the patient, remain responsible for payment of the account regardless of medical scheme benefits or payment outcomes, including where payment is made directly to the member.
- I understand that the account is calculated based on time-related costs, procedural modifiers, and patient-specific factors, and that any estimate provided is subject to adjustment based on these factors and any unforeseen circumstances.
- I understand that my anaesthetist is not contracted to all medical schemes and that the billing policy may be above medical aid rates.
- I accept full responsibility for payment of the anaesthetic account.
Payments and Administration
- I understand that all EFT payments must include the correct reference number.
- I understand that the anaesthetist cannot be held responsible for delays, misallocation, or additional costs arising from incorrect or missing references.
Declarations and Consent
- I declare that the anaesthetic account will not form part of any administration order in the guarantor’s name.
- I declare that all personal information provided by me is true and correct.
- I accept responsibility for any legal, collection, and tracing costs incurred due to non-payment, calculated on an attorney and client scale.
- I declare that, if I am not the guarantor, I have obtained the guarantor’s permission to sign this agreement.
- I consent to the collection and processing of my personal and medical information for purposes related to my treatment and administration.
- I hereby give informed consent for the administration of anaesthesia as deemed appropriate by the anaesthetist.
- I confirm that I have read and understood the full contents of this document and accept all terms and conditions, including those set out in the Billing Policy.