{"text":". MULTIDISCIPLINARY NOTES \nDATE \/ TIME \nDISCHARGE YES NO \n1. STABLE VITAL SIGNS [ ] | \n2. CANNULAE REMOVED [] || \n3. ABLE TO DRESS, SIT AND WALK UNAIDED \/ :I | \n4: TOLERATING FOOD AND FLUIDS ] [ ] \n5. INSTRUCTIONS GIVEN SEDATION [ \n6. GP LETTER GIVEN BEFORE DISCHARGE B \n7. FOLLOW UP APPOINTMENT [ ] \nDISCHARGE AT ' TO | CARE \nNURSE\u2019S SIGNATURE \nCONSENT FORM . - \ni . Special requirements (e.g. other language \/ \ni Communication method) ......c.ccoviniiciiereeieniineene e, \n| Proposed operation, mvestlgatron or other treatment. \nPatient Label i (BLOCK CAPITALS) \n.............................................................. \n................................................................................................. \n[ have explained the procedure named on this form to the patient in the terms which, in my \njudgement, are suited to their understanding. In particular, | have fully explained: the intended \nbenefits; appropriate alternatives which are available (including no treatment); any sign if cant risks \nwhich may result from the procedure and any extra procedures which may become necessary during \nthe procedure (please specify major procedure above). - \nAn information [eaflet\/tape has been provided ..........c.cccooveiiiniiiiiniiiniietee e \nSeassetasasersststsesesetontaniue saseresetet aann et sasiotastsn LN RS saesas AR S an bt et S S es RS S USRS SSS (Title) \nSignature'of Practitioner ................... freesennreeeses s st ee e r e e e s eatee et te e seen e s s s aaennras \nName \/ Designation (Print) ......ccceeennnsliniiiinanens eeenereeennas teerreeee st rereeneeans \nDate............ 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