CUH

All consent forms

Click on the headings to sort leaflets

Title of leaflet (click to sort) Service/Dept. (click to sort) Ref no. (click to sort)

Immunoglobulin replacement therapy

Allergy

CF 0363

Breast localisation prior to surgery

Breast Unit

CF 0209

Axillary clearance

Breast Unit

CF 0210

Breast biopsy – core biopsy under ultrasound guidance

Breast Unit

CF 0211

Breast surgery: localisation and diagnostic excision biopsy

Breast Unit

CF 0212

Duct clearance or microdochectomy

Breast Unit

CF 0213

Breast surgery: excision biopsy

Breast Unit

CF 0214

Breast surgery: wide excision of the nipple and areola complex

Breast Unit

CF 0215

Breast surgery: male mastectomy and axillary clearance

Breast Unit

CF 0216

Breast biopsy – mammotome under stereotactic guidance

Breast Unit

CF 0217

Breast Surgery: Mastectomy

Breast Unit

CF 0219

Breast surgery: mastectomy and axillary clearance

Breast Unit

CF 0220

Breast surgery: re-excision

Breast Unit

CF 0221

Breast surgery: re-excision & axillary clearance

Breast Unit

CF 0222

Localisation and wide local excision and axillary clearance

Breast Unit

CF 0223

Breast surgery: wide local excision

Breast Unit

CF 0224

Breast surgery: wide local excision and axillary clearance

Breast Unit

CF 0225

Breast surgery: localisation and wide local excision

Breast Unit

CF 0226

Breast surgery – wide excision of the nipple and areola complex and axillary clearance

Breast Unit

CF 0227

Breast biopsy – punch biopsy

Breast Unit

CF 0228

Breast Surgery: Wide local excision and sentinel lymph node (SLN) biopsy +/- axillary clearance

Breast Unit

CF 0229

Breast Surgery: Excision of recurrence in breast/chest wall

Breast Unit

CF 0250

Localisation and wide local excision and sentinel lymph node (SLN) biopsy +/- axillary Clearance

Breast Unit

CF 0340

Breast surgery: mastectomy and sentinel lymph node (SLN) biopsy +/- axillary clearance

Breast Unit

CF 0341

Breast Surgery: Male mastectomy and sentinel lymph node (SLN) biopsy +/- axillary clearance

Breast Unit

CF 0342

Breast surgery: Wide excision of the nipple and areola complex and sentinel lymph node (SLN) biopsy +/- axillary clearance

Breast Unit

CF 0343

Breast Surgery: Sentinel lymph node (SLN) biopsy +/- axillary clearance

Breast Unit

CF 0344

Elective day-case cardioversion

Cardiology (Heart)

CF 0020

Cardiac catheterisation and coronary angiography

Cardiology (Heart)

CF 0022

Dobutamine Stress Echocardiography

Cardiology (Heart)

CF 0411

Donation of brain and related bodily fluids by donor

Cambridge Brain Bank

CF 0413

Donation of brain and related bodily fluids by a person in a qualifying relationship

Cambridge Brain Bank

CF 0414

Registration of intent - donation of brain and related bodily fluids by a person in a qualifying relationship

Cambridge Brain Bank

CF 0415

Colonoscopy and Gastroscopy - Children’s Services

Children's Services

CF 0375

Colonoscopy - Children’s Services

Children's Services

CF 0376

Gastroscopy (upper endoscopy) - Children’s Services

Children's Services

CF 0377

Gastroscopy (upper endoscopy) and impedance study

Children's Services

CF 0403

Anal fistula - surgery

Colorectal Unit

CF 0130

Lateral internal anal sphincterotomy for anal fissure

Colorectal Unit

CF 0131

Appendicectomy (removal of an inflamed appendix)

Colorectal Unit

CF 0132

Anterior resection for rectal cancer

Colorectal Unit

CF 0133

Colectomy

Colorectal Unit

CF 0134

Haemorrhoidectomy

Colorectal Unit

CF 0135

Minor anorectal surgery (skin tags, fibroepithelial polyps, external haemorrhoids, warts)

Colorectal Unit

CF 0137

Formation of ileo-anal pouch

Colorectal Unit

CF 0270

Abdomino Perineal Excision of Rectum (A.P.E.R.)

Colorectal Unit

CF 0271

Transanal Endoscopic Microsurgery (TEMS)

Colorectal Unit

CF 0397

Doppler-Guided Haemorrhoidal Artery Ligation

Colorectal Unit

CF 0416

Iontopheresis (a mild electric current, to reduce sweating) to hands and /or feet

Dermatology (Skin)

CF 0030

Photodynamic Therapy (PDT)

Dermatology (Skin)

CF 0031

PUVA Therapy

Dermatology (Skin)

CF 0032

UVB Therapy

Dermatology (Skin)

CF 0033

Iontopheresis (a mild electric current, to reduce sweating) to hands and /or feet, and/ or axillae using tap water

Dermatology (Skin)

CF 0035

Diphencyprone: topical immunotherapy

Dermatology (Skin)

CF 0401

Subtotal or total thyroidectomy (surgery on the thyroid gland) for Grave’s disease

Endocrine services

CF 0160

Parathyroidectomy: Removal of the parathyroid glands of the neck because of primary hyperparathyroidism (HPT)

Endocrine services

CF 0161

Subtotal or total thyroidectomy (surgery on the thyroid gland) for nodular thyroid disease

Endocrine services

CF 0162

Parathyroidectomy: Removal of the parathyroid glands of the neck because of renal hyperparathyroidism (RHPT)

Endocrine services

CF 0163

Endoscopic procedures

Endoscopy

CF 0040

Endoscopic procedures - child or young person

Endoscopy

CF 0041

Tonsillectomy

ENT (Ear, Nose and Throat)

CF 0110

Mastoid Obliteration

ENT (Ear, Nose and Throat)

CF 0111

Ossiculoplasty

ENT (Ear, Nose and Throat)

CF 0112

Myringoplasty

ENT (Ear, Nose and Throat)

CF 0367

Otosclerosis and Stapedectomy

ENT (Ear, Nose and Throat)

CF 0368

Mastoid Surgery

ENT (Ear, Nose and Throat)

CF 0370

Electrocochleogram

ENT (Ear, Nose and Throat)

CF 0396

Amniocentesis

Fetal Medicine

CF 0238

Chorionic villus sampling

Fetal Medicine

CF 0239

Bowel retraining

Gastroenterology

CF 0050

Stationary oesophageal manometry

Gastroenterology

CF 0051

Consent form - patient agreement to investigation or treatment (for adults and children)

For patients

WZO327

Consent form - patient agreement to investigation or treatment for neurosurgery, spinal surgery or vitreoretinal surgery

For patients

WZO566

Supplementary consent to investigation or treatment by patient who refuses to have a blood transfusion

For patients

Form for adults to lack the capacity to consent to investigation or treatment including assessment of mental capacity

For patients

Evacuation of retained products of conception (ERPOC) (for example: after a miscarriage)

Gynaecology

CF 0230

Hysteroscopic surgery

Gynaecology

CF 0231

Laparoscopic sterilisation

Gynaecology

CF 0232

Laparoscopic (key-hole) ovarian surgery

Gynaecology

CF 0233

Laparoscopic assisted vaginal hysterectomy with or without bilateral salpingo-oophorectomy (LAVH +/- BSO)

Gynaecology

CF 0234

Termination of pregnancy - surgical

Gynaecology

CF 0235

Termination of early pregnancy with Mifepristone and Prostaglandin

Gynaecology

CF 0236

Mid trimester termination of pregnancy with Prostaglandin. Pre-treatment with Mifepristone.

Gynaecology

CF 0237

Interval debulking surgery

Gynaecology

CF 0240

Primary surgery for gynaecological cancer (laparotomy and total hysterectomy, bilateral salpingo-oophorectomy and staging)

Gynaecology

CF 0241

Miscarriage - medical management

Gynaecology

CF 0245

Diagnostic Laparoscopy

Gynaecology

CF 0252

Total abdominal hysterectomy

Gynaecology

CF 0254

Medical management of pregnancy of unknown location using Methotrexate

Gynaecology

CF 0432

Medical management of an ectopic pregnancy using Methotrexate

Gynaecology

CF 0433

Haemophilia treatment with clotting factors and viral surveillance - patient agreement to investigation or treatment

Haematology

CF 0060

Haemophilia treatment with clotting factors and viral surveillance - parental agreement to investigation or treatment

Haematology

CF 0061

Subcutaneous injection of DDAVP (Octostim, desmopressin acetate)

Haematology

CF 0062

Subcutaneous injection of DDAVP (Octostim, desmopressin acetate) - parental agreement to investigation or treatment

Haematology

CF 0063

Distal or sub-total pancreatectomy (surgery on the pancreas)

Hepato-Pancreato-Biliary Cancer Service

CF 0140

Laparoscopic adrenalectomy

Hepato-Pancreato-Biliary Cancer Service

CF 0141

Laparoscopic cholecystectomy

Hepato-Pancreato-Biliary Cancer Service

CF 0142

Liver resection

Hepato-Pancreato-Biliary Cancer Service

CF 0143

Pancreatectomy (removal of the pancreas)

Hepato-Pancreato-Biliary Cancer Service

CF 0144

Whipple’s resection (pancreatico-duodenectomy)

Hepato-Pancreato-Biliary Cancer Service

CF 0145

Percutaneous Transhepatic Cholangiography (PTC)

Hepato-Pancreato-Biliary Cancer Service

CF 0405

Caesarean section with sterilisation - elective

Maternity

CF 0242

Caesarean section

Maternity

CF 0243

External cephalic version (ECV)

Maternity

CF 0244

Wisdom teeth - surgical removal of impacted wisdom teeth

Oral & Maxillofacial Surgery (Mouth & Face)

CF 0300

Jaw/chin corrective surgery (orthognathic surgery)

Oral & Maxillofacial Surgery (Mouth & Face)

CF 0301

Bone Biopsy

Metabolic Bone Disease

CF 0070

Cervical discectomy for cervical myelopathy (pressure on the spinal cord) or Cervical radiculopathy (pressure on a nerve root)

Neurosciences (Brain and Nerves)

CF 0080

Lumbar discectomy

Neurosciences (Brain and Nerves)

CF 0081

Lumbar laminectomy

Neurosciences (Brain and Nerves)

CF 0082

Acoustic neuroma - Surgical removal

Neurosciences (Brain and Nerves)

CF 0083

Cervical Laminectomy

Neurosciences (Brain and Nerves)

CF 0084

Botulinum Toxin injection for cervical Dystonia (Spasmodic Torticollis)

Neurosciences (Brain and Nerves)

CF 0085

Botulinum toxin injection for hemifacial spasm

Neurosciences (Brain and Nerves)

CF 0086

Botulinum toxin injection for spasticity

Neurosciences (Brain and Nerves)

CF 0350

Carotid endarterectomy - surgery of the carotid arteries

Neurosciences (Brain and Nerves)

CF 0364

Biopsy of brain tumour in adults

Neurosciences (Brain and Nerves)

CF 0384

Craniotomy and resection of brain tumour in adults

Neurosciences (Brain and Nerves)

CF 0385

Craniotomy and resection of brain tumour followed by insertion of Gliadel implants in adults

Neurosciences (Brain and Nerves)

CF 0386

Insertion of a deep brain stimulator (DBS)

Neurosciences (Brain and Nerves)

CF 0391

Insertion of lumbar peritoneal shunt

Neurosciences (Brain and Nerves)

CF 0392

Insertion of ventriculo-peritoneal and ventriculo-atrial shunt

Neurosciences (Brain and Nerves)

CF 0393

Lumbar infusion study

Neurosciences (Brain and Nerves)

CF 0394

Infusion study through a reservoir and proceed to a shunt insertion if needed

Neurosciences (Brain and Nerves)

CF 0395

Lumbar puncture

Neurosciences (Brain and Nerves)

CF 0407

CSF Infusion study via reservoir or valve pre-chamber

Neurosciences (Brain and Nerves)

CF 0406

Surgery for unruptured intracranial aneurysms

Neurosciences (Brain and Nerves)

CF 0380

Extracranial to intracranial bypass surgery to reduce the chances of future strokes

Neurosciences (Brain and Nerves)

CF 0381

*………………............... laminectomy and excision of intradural tumour

Neurosciences (Brain and Nerves)

CF 0387

Thoracic Laminectomy

Neurosciences (Brain and Nerves)

CF 0390

Posterior fossa decompression for chiari malformation

Neurosciences (Brain and Nerves)

CF 0389

Surgery for ruptured intracranial aneurysms

Neurosciences (Brain and Nerves)

CF 0423

Cerebral Angiogram of the brain

Neurosciences (Brain and Nerves)

CF 0431

Neonatal Intensive Care Unit - consent for immunisations of neonates

Neonatal Intensive Care Unit (NICU)

CF 0260

Neonatal Intensive Care Unit - consent for immunisations of neonates - BCG etc

Neonatal Intensive Care Unit (NICU)

CF 0261

Neonatal Intensive Care Unit - donating breast milk to the breast milk bank

Neonatal Intensive Care Unit (NICU)

CF 0262

Bone marrow harvest

Oncology (Cancer)

CF 0090

Blood or marrow transplant

Oncology (Cancer)

CF 0091

Peripheral blood stem cell mobilisation and collection

Oncology (Cancer)

CF 0092

Oncology / Haematology Centre consent form 1

Oncology (Cancer)

CF 0093

Allogeneic donor peripheral blood stem cell mobilisation and collection

Oncology (Cancer)

CF 0094

Allogeneic bone marrow harvest

Oncology (Cancer)

CF 0095

Leukaemia treatment - routine procedures under general anaesthetic for the whole course of treatment

Oncology (Cancer)

CF 0280

Lymphoma treatment - routine procedures under general anaesthetic for the whole course of treatment

Oncology (Cancer)

CF 0281

Botulinum toxin injection for blepharospasm (spasm of the eyelids)

Ophthalmology (Eye Surgery)

CF 0120

Photodynamic therapy (PDT) for wet age-related macular degeneration (AMD)

Ophthalmology (Eye Surgery)

CF 0125

Orthodontic Treatment

Oral & Maxillofacial Surgery (Mouth & Face)

CF 0302

Syringe and probing of the nasolacrimal (tear) ducts

Paediatric Ophthalmology

CF 0121

Squint surgery - children

Paediatric Ophthalmology

CF 0122

Tissue typing: Donating a blood sample

Pathology

CF 0173

Acupuncture

Physiotherapy

CF 0103

Abdominoplasty (plastic surgery on the abdomen)

Plastic Surgery

CF 0150

Augmentation mammaplasty (to enlarge your breasts)

Plastic Surgery

CF 0151

Pinnaplasty: Correction of prominent ear(s)

Plastic Surgery

CF 0153

Rhinoplasty: Plastic surgery of the nose

Plastic Surgery

CF 0154

Nipple-areola micro pigmentation (nipple colouring) after reconstructive breast surgery

Plastic Surgery

CF 0158

Central venous catheter for haemodialysis - insertion

Renal (Nephrology)

CF 0321

Bronchoscopy

Respiratory Medicine (Lungs)

CF 0042

Pleural biopsy

Respiratory Medicine (Lungs)

CF 0043

Chest drain insertion

Respiratory Medicine (Lungs)

CF 0044

Pilonidal Sinus

General surgery

CF 0138

Paraumbilical hernia surgery

General surgery

CF 0139

Abdomino Perineal Excision of Rectum (A.P.E.R.)

General surgery

CF 0756

Solitary pancreas transplantation

Transplant

CF 0169

Simultaneous kidney and pancreas transplantation

Transplant

CF 0170

Kidney transplantation

Transplant

CF 0171

Liver transplantation

Transplant

CF 0172

Laparoscopic live donor nephrectomy (removal of kidneys from live donors using a key-hole technique)

Transplant

CF 0174

Laparoskopická nefrektómia žijúceho darcu (vyňatie obličiek živým darcom použitím techniky „kľúčovej dierky“)

Transplant

CF 0174

Kidney transplantation – information for higher risk recipients

Transplant

CF 0175

Living liver donation work-up

Transplant

CF 0176

Live donor hepatectomy (removal of part of the liver for the purpose of transplantation)

Transplant

CF 0378

Live donor liver transplantation (using part of a liver from a living donor)

Transplant

CF 0400

Creation of arteriovenous fistula

Transplant

CF 0435

Correction of claw (mallet) toe

Trauma and Orthopaedics

CF 0180

Hallux Rigidus (arthritis of the big toe) either cheilectomy or fusion

Trauma and Orthopaedics

CF 0181

Metatarsal osteotomy (bunion surgery)

Trauma and Orthopaedics

CF 0182

Ingrowing toenail - removal

Trauma and Orthopaedics

CF 0183

Morton’s neuroma (one cause of a pain in the ball of the foot)

Trauma and Orthopaedics

CF 0184

Correction of claw (mallet) toe and metatarsal osteotomy (bunion surgery)

Trauma and Orthopaedics

CF 0185

Hip arthroplasty (replacement)

Trauma and Orthopaedics

CF 0186

Open Inguinal Hernia Surgery

Upper Gastrointestinal (GI) Unit  

CF 0136

Laparoscopic Nissen Fundoplication for Gastro-oesophageal reflux

Upper Gastrointestinal (GI) Unit

CF 0147

Laparoscopic Cholecystectomy

Upper Gastrointestinal (GI) Unit

CF 0192

Laparoscopic Pre-peritoneal Inguinal Hernia Repair

Upper Gastrointestinal (GI) Unit  

CF 0193

Oesophagectomy

Upper Gastrointestinal (GI) Unit  

CF 0194

Staging Laparoscopy

Upper Gastrointestinal (GI) Unit  

CF 0195

Total Gastrectomy

Upper Gastrointestinal (GI) Unit  

CF 0196

Open Cholecystectomy

Upper Gastrointestinal (GI) Unit  

CF 0417

Merendino procedure

Upper Gastrointestinal (GI) Unit  

CF 0421

Laparoscopic abdominal wall hernia surgery

Upper Gastrointestinal (GI) Unit  

CF 0420

Abdominal wall hernia surgery

Upper Gastrointestinal (GI) Unit  

CF 0419

Laparoscopic groin hernia repair

Upper Gastrointestinal (GI) Unit  

CF 0418

Surgery for a para-oesophageal hernia

Upper Gastrointestinal (GI) Unit  

CF 0422

PICC - insertion

Vascular Access Team

CF 0247

Portacath - insertion

Vascular Access Team

CF 0248

Central venous catheter - insertion

Vascular Access Team

CF 0320

Abdominal aortic aneurysm (AAA) - surgery

Vascular Surgery

CF 0200

Carotid arteries surgery – carotid endarterectomy

Vascular Surgery

CF 0201

Hyperhidrosis - surgery (excessive sweating)

Vascular Surgery

CF 0202

Long saphenous varicose veins (in the leg) - surgery

Vascular Surgery

CF 0203

Short saphenous varicose veins (in the calf of the leg) - surgery

Vascular Surgery

CF 0204

Femoro-popliteal and/or femoro-crural bypass (to improve the blood flow in the leg)

Vascular Surgery

CF 0205

Lower limb amputation (permanent surgical removal of part of the foot/leg)

Vascular Surgery

CF 0206

Axillo-Femoral / axillo-profunda bypass (to improve the blood flow in the leg)

Vascular Surgery

CF 0207

Endovascular repair of abdominal aortic aneurysm (EVAR) – ‘key hole’ repair of a ballooned artery in your abdomen

Vascular Surgery

CF 0208

Endovascular repair of Thoracic aortic aneurysm – ‘key hole’ repair of a ballooned artery in your chest

Vascular Surgery

CF 0246

 

 

 

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