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I have read the above information and understand the indications for, and risks of this examination. I consent to the taking and reproduction of any photographs of the procedure for professional purposes.
I hereby authorize and permit ,
M.D. to perform upon me the procedure liver biopsy.
If you have any questions after reading this form, please feel free to ask them before giving your consent.
Post Procedure
Please arrange to have someone pick you up after the liver biopsy. The hospital will not permit you to use public transportation. A taxi may be used only if a responsible adult accompanies you. DO NOT drive a car for 12 hours after the liver biopsy
General Instructions:
- Rest the remainder of the day.
- No driving today.
- No heavy lifting (greater than 10 pounds) for the next 24 hours.
- Other than the lifting restriction, you may resume your regular activities tomorrow.
- Avoid aspirin or ibuprofen for the next week.
- You may take acetaminophen (Tylenol), 1 or 2 tablets, every four hours as needed for discomfort.
- You may remove the bandage tomorrow and replace it with a simple Band-Aid, if necessary.
Notify your doctor if you experience:
- Pain which cannot be controlled with Tylenol.
- Bleeding at the site of the biopsy
- A fever greater than 100 degrees.
You may call your doctor's office in 7-10 days to receive the results of your biopsy .
Preparation for Liver Biopsy
1.) No aspirin, aspirin-containing products or other similar drugs such as Advil or Motrin for one week prior and subsequent to the procedure. Use Tylenol for headache.
2). Nothing to eat, drink, chew or smoke after midnight the night of the examination.
3). Please arrange to have someone pick you up after the procedure. Do not drive a car for 12 hours after the procedure as the medicine you will be given makes you drowsy.
4). Please report to Suite: 650 at 8316 Arlington Blvd. Yorktown 50 Bldg.
ARRIVAL TIME:
PROCEDURE TIME:
DATE:
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