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20.7.9.1 Sterilization Consent Form Instructions
Clients must be 21 years of age or older when the consent form is signed. If the client was 20 years of age or younger when the consent form was signed, the consent is denied. Changing signature dates is considered fraudulent and is reported to the Office of the Inspector General (OIG).
There must be at least 30 days between the date the client signs the consent form and the date of surgery, with the following exceptions:
• Premature delivery-There must be at least 30 days between the date of consent and the client's expected date of delivery.
•Cases of emergency abdominal surgery not associated with pregnancy-There must be at least 72 hours between the date of consent and the date of surgery. Operative reports detailing the need for emergency surgery are required.
Listed below are field descriptions for the Sterilization Consent Form published in this manual. Completion of all sections is required to validate the consent form, with only two exceptions:
•Race and ethnicity designation is requested but not required.
•The Interpreter's Statement is not required as long as the consent form is written in the client's language or the person obtaining the consent speaks the client's language; however, if this section is only partially completed, the consent is not accepted as a valid consent.
This Sterilization Consent Form may be copied for provider use. Providers are encouraged to frequently recopy the original form to ensure legible copies and to expedite consent validation. Providers must fax fully completed Sterilization Consent Forms to TMHP at 1-512-514-4229.
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