Sedation Informed Consent

The Sedation Informed Consent has been updated to align with the updated Sedation Policy and Sedation Guidelines published in May 2022. The consent can be printed locally or copies can be ordered via iPrint for your hospital or clinic, and is available in English, Arabic, Chinese, Portuguese, Vietnamese, and Spanish. The Sedation Informed Consent needs to be fulfilled any time a non-anesthesia provider is administering/directing sedation for a procedure or treatment. In cases where an anesthesia provider administers sedation, a Consent of Anesthesia Services must be used (also orderable on iPrint: search “MR906”).

• Added option for targeted "Deep Sedation"
• Added clarifying language for Minimal Sedation requiring consent for IV sedation in the office or clinic settings 
• Removed section for Fact Sheet Provided
  • Documented under ‘Handouts Provided’ in Interactive View I/O- or through Patient Education from caregiver Workflow Pages
• Added section for Licensed Clinician Witness Signature, which is required per CMS

1. All areas Remove the outdated Sedation Informed Consent from your departments
   • Remove all Sedation Informed Consent forms dates 11/2020 or older
   • Remove all “Acknowledgement of Consent for Sedation” forms from 1/2017 or older
2. Order and replace your stock with new version of the Sedation Informed Consent
   • Print on demand or order directly from the Sedation Informed Consent
   • Or order multiple copies from iPrint: type “Sedation Informed Consent” in search and locate appropriate consent in language preferred
     • Sedation Informed Consent IHCMR986 8/2022 (English)
     • Sedation Informed Consent IHCMR986 8/2022 (Spanish)
     • Sedation Informed Consent IHCMR986 8/2022 (Arabic)
     • Sedation Informed Consent IHCMR986 8/2022 (Brazilian Portuguese)
     • Sedation Informed Consent IHCMR986 8/2022 (Simplified Chinese)
     • Sedation Informed Consent IHCMR986 8/2022 (Vietnamese)