{"text":"L& \nAN \n| Patient\u2019s first name \nPatient Agreement to !nvestlgatlon or Treatment - NHS \nconsent Form ' \u00bb \u2019 . Gre;rt\u2018%ra;?\u00e9ego:u \net dals v progisd Ebc) - | \nHospital \/ clinic \/ GP practice IHM!IMJHWWIMMWMHM \n. CLELLAND F\u2014 \n.'Patien,t;'s_ surname \/ family name nes bose 08\/08\/1955 \nKilsyth \nGlasgow, Lanarkshire \nG865 9PQ \nDate of birth : Gender Male D Female D \nCHI number. \nSpecial req'ui\u2018rements'(e.g. other language \/ communication method) \nsmlamm{tw \nb@\ufb02n@ym@? \nDescribe proposed operation, investigation, or-other treatmerit. \nWhere appropnate specify site or side (write in full), \n\u2019M (0 Fusien P MTAT \n(57 HGMW\\w 2-4 Toe W@L \nSpecn\ufb01c nsks \/ complications. - \nPlease detail ariy specific risk\/complications related to the procedure that were discussed. \ne | \ni, R i \n| DT O Cwnimy | ngbv, volerms \n\u20181 have explained-the procedure named on this form to the patient in terms which, in my \njudgement, are suited to their understanding. In particular, i have fully explained: the intended \nbenefits; appropriate alternatives which are available (including no treatment); any significant \nrisks which may result from the procedure; and any extra procedures which may become \n{ necessary during the procedure (please specify major procedures above). | have explained who \nwill be domg the procedure if not myself. \nSlgnature of practltloner U \nName \/ Designation (print) A VATS : CO*MM Ovlo \nP 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