Informed Consent - Medical Imaging
Adult | Child/Young Person
Please note: The Medical Board of Australia has published Guidelines: Sexual boundaries in the doctor-patient relationship. These guidelines, which came into effect on 12 December 2018, provide guidance on establishing and maintaining sexual boundaries in the doctor-patient relationship. To support hospitals/individual health practitioners/patients to comply with these guidelines, our Informed Consent forms and Patient Information sheets for procedures requiring intimate examinations, have been updated in the relevant surgical areas, indicated below by an (*).
Two separate additional student consent forms (adult and child/young person), indicated below by an (**), are to be used for patients to complete if the procedure is yet to occur and prior consent has been undertaken on the previous version of informed consent forms, or if the procedure consent form does not have a student section included.
A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | Y | Z
| Index | Procedure List | File Size |
|---|---|---|
| A | A Additional Student Consent ** | 2.7 MB |
| Adenosine - MRI Cardiac Stress Perfusion Study | 114 KB | |
| Adrenal Vein Sampling | 127 KB | |
| Amniocentesis/Chorionic Villus Sampling * | 3.2 MB | |
| Anaesthetic | 66 KB | |
| Anorectal Physiology and Endoanal Ultrasound * | 5.06 MB | |
| Angiogram Consent* | 837 KB | |
| Angiogram is superseded by Angiogram Consent* | ||
| Angiogram &/-Plasty / Stenting is superseded by Angiogram Consent* | ||
| Angioplasty is superseded by Angiogram Consent* | ||
| Antenatal Ultrasound Guided Procedure | 37 KB | |
| Arterial Stent is superseded by Angiogram Consent* | ||
| Arteriogram is superseded by Angiogram Consent* | ||
| Arthrogram (Image-Guided) Consent | 636 KB | |
| Arthrogram is superseded by Arthrogram (Image-Guided) Consent | ||
| Aspiration/Drainage (Image-Guided) Consent * | 1.6 MB | |
| Aspiration is superseded by Aspiration/Drainage (Image-Guided) Consent * | ||
| Aspiration - Breast * is superseded by Aspiration/Drainage (Image-Guided) Consent * | ||
| Aspiration - Chest is superseded by Thoracentesis Consent |
| Index | Procedure List | File Size |
|---|---|---|
| B | Barium Enema | 40 KB |
| Biliary Drain Insertion is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent | ||
| Biliary Stent Insertion is superseded by Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent | ||
| Biopsy (Image-Guided) Consent * | 580 KB | |
| Biopsy - Chest is superseded by Biopsy (Image-Guided) Consent * | ||
| Biopsy - Other is superseded by Biopsy (Image-Guided) Consent * | ||
| Biopsy - Superficial * is superseded by Biopsy (Image-Guided) Consent * | ||
| Biopsy - TRUS is superseded by Biopsy (Image-Guided) Consent * | ||
| Blood transfusion consent and refusal forms are now located under Blood specialty. | ||
| Bone Biopsy is superseded by Biopsy (Image-Guided) Consent * | ||
| Breast Aspiration * is superseded by Aspiration/Drainage (Image-Guided) Consent * | ||
| Breast Biopsy * is superseded by Biopsy (Image-Guided) Consent * | ||
| Breast Imaging * | 788 KB |
| Index | Procedure List | File Size |
|---|---|---|
| D | Dacrocystogram | 488 KB |
| Defaecogram * | 278 KB | |
| Dental Imaging * | 680 KB | |
| Discogram | 85 KB | |
| Dobutamine Stress Study MRI | 148 KB | |
| Drainage is superseded by Aspiration/Drainage (Image-Guided) Consent * |
| Index | Procedure List | File Size |
|---|---|---|
| E | Embolisation - Cerebral Coiling | 140 KB |
| Embolisation - CNS | 102 KB | |
| Embolisation Consent* | 642 KB | |
| Embolisation - Other is now superseded by Embolisation Consent * | ||
| Embolisation of the Uterine Artery (EUA) Consent * | 608 KB | |
| Embolisation Uterine Artery (EUA) is now superseded by Embolisation of the Uterine Artery (EUA) Consent * | ||
| Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic Stroke | 6.5 MB | |
| Enteroclysis / Small Bowel Study * | 506 KB | |
| Enteroclysis is now superseded by Enteroclysis / Small Bowel Study | ||
| Enema | 40 KB | |
| Epidural Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent |
| Index | Procedure List | File Size |
|---|---|---|
| F | Facet Joint Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent | |
| Fetal Ultrasound - Nuchal Translucency | 76 KB | |
| Fetal Ultrasound - Obstetric | 76 KB | |
| Fine Needle Aspiration (FNA) is superseded by Biopsy (Image-Guided) Consent * | ||
| Fistulogram (AV) is superseded by Venogram Consent | ||
| Fistulogram / Sinogram * | 412 KB | |
| Fluoroscopy Swallow / Meal | 531 KB | |
| G | Gastrostomy Insertion Consent | 608 KB |
| Gastrostomy is superseded by Gastrostomy Insertion Consent | ||
| Gastrostomy Check is superseded by Catheter Check with Iodinated Contrast | ||
| Gastrografin Enema * | 41 KB | |
| Generic Medical Imaging Consent | 224 KB | |
| Generic Nuclear Medicine Consent | 75 KB | |
| Generic Ultrasound Guided Antenatal Procedure * | 3.2 MB | |
| Groin Biopsy * is superseded by Biopsy (Image-Guided) Consent * |
| Index | Procedure List | File Size |
|---|---|---|
| H | Hickman Catheter Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent* | |
| Hickman Catheter Check is superseded by Catheter Check with Iodinated Contrast | ||
| Hydrodilatation is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent | ||
| Hysterosalpingogram (HSG) * | 556 KB |
| Index | Procedure List | File Size |
|---|---|---|
| I | Inferior Vena Cava (IVC) Filter Insertion Consent | 1.2 MB |
| Inferior Vena Cava (IVC) Filter Removal Consent | 1.1 MB | |
| Intercostal Catheter (ICC) Insertion Consent | 678 KB | |
| InterCostal Catheter (ICC) Insertion is superseded by Intercostal Catheter (ICC) Insertion Consent | ||
| Interventional Procedure - Any Interventional Procedure Requiring Consent | 72 KB | |
| Intrathecal Chemotherapy Lumbar Puncture is superseded by Lumbar Puncture (Intrathecal Chemotherapy) Consent | ||
| Intrauterine Blood Transfusion | 37 KB | |
| Iodine-131 Therapy for Hyperthyroidism | 101 KB | |
| IVC Filter Removal is superseded by Inferior Vena Cava (IVC) Filter Removal Consent | ||
| IVC Filter Insertion is superseded by Inferior Vena Cava (IVC) Filter Insertion Consent |
| Index | Procedure List | File Size |
|---|---|---|
| J | Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent | 852 KB |
| Joint Injections - Other is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent | ||
| L | Liver Biopsy is superseded by Biopsy (Image-Guided) Consent* | |
| Liver Biopsy Under Imaging superseded by Biopsy (Image-Guided) Consent * | ||
| Liver Biopsy - Transjugular is superseded by Transjugular Liver Biopsy Consent | ||
| Lumbar Puncture (Image-Guided) Consent | 722 KB | |
| Lumbar Puncture (LP) is now superseded by Lumbar Puncture (Image-Guided) Consent | ||
| Lumbar Puncture (Intrathecal Chemotherapy) Consent | 788 KB | |
| Lung Biopsy is superseded by Biopsy (Image-Guided) Consent * |
| Index | Procedure List | File File |
|---|---|---|
| M | Magnetic Resonance Imaging (MRI) Scan Consent | 634 KB |
| Magnetic Resonance Imaging (MRI) Scan | 473 KB | |
| Mammary Ductogram * | 603 KB | |
| Medical Imaging Generic Consent | 72 KB | |
| Micturating CystoUrethrogram (MCU) is now superseded Cystogram / Urethrogram / Micturating Cysto-Urethrogram * | ||
| MRI Cardiac Stress Perfusion | 114 KB | |
| MRI Dobutamine Stress Study | 148 KB | |
| Myocardial Perfusion Scan | 86 KB |
| Index | Procedure List | File Size |
|---|---|---|
| N | Nasogastric Tube Check is superseded by Catheter Check with Iodinated Contrast | |
| Nephrostogram | 319 KB | |
| Nephrostomy with or without Ureteric Stent Insertion Consent | 846 KB | |
| Nephrostomy is superseded by Nephrostomy with or without Ureteric Stent Insertion Consent | ||
| Nerve Root Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent | ||
| Nuchal Translucency Ultrasound * | 438 KB | |
| Nuclear Medicine Generic Consent | 75 KB | |
| O | Obstetric Ultrasound * | 488 KB |
| Index | Procedure List | File Size |
|---|---|---|
| R | Radiation and Medical Imaging | 33 KB |
| Radio Frequency Ablation (RFA) is superseded by Thermal Ablation Consent | ||
| Radio-guided Occult Lesion Localisation using Iodine-125 Seeds (ROLLIS) Consent * | 639 KB | |
| Renal Biopsy is superseded by Biopsy (Image-Guided) Consent * | ||
| Renal Renin Sampling | 130 KB | |
| S | Saline Sonogram * | 101 KB |
| Sclerotherapy Consent* | 638 KB | |
| Selective Internal Radiation Therapy (SIRT) Consent | 580 KB | |
| Selective Internal Radiation Therapy (SIRT) is superseded by Selective Internal Radiation Therapy (SIRT) Consent | ||
| Sialogram * | 392 KB | |
| Sinogram / Fistulogram * | 412 KB | |
| Small Bowel Series / Follow Through | 367 KB | |
| Small Bowel Enema is now superseded by Enteroclysis / Small Bowel Study | 406 KB | |
| Spinal Injection is superseded by Joint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent | ||
| Superficial Biopsy is superseded by Biopsy (Image-Guided) Consent * | ||
| Swallow / Meal is now superseded by Fluoroscopy Swallow / Meal |
| Index | Procedure List | File Size |
|---|---|---|
| U | Ultrasound Scan * | 496 KB |
| Ultrasound Scan - Nuchal Translucency | 76 KB | |
| Ultrasound Scan - Obstetric | 73 KB | |
| Ureteric Stent is superseded by Nephrostomy with or without Ureteric Stent Insertion Consent | ||
| Urethrogram is superseded by Cystogram / Urethrogram / Micturating Cysto-Urethrogram * | ||
| V | Vascath Insertion is superseded by Central Vascular Access Device (CVAD) Insertion Consent* | |
| Vasospasm (Cerebral) Treatment | 135 KB | |
| Venogram Consent | 645 KB | |
| Venogram is superseded by Venogram Consent | ||
| Vertebroplasty | 86 KB | |
| V/Q Scan in Pregnancy | 82 KB | |
| Y | Yttrium-90 Colloid Therapy for Joint Pain and Swelling | 89 KB |
Last updated: 21 September 2023
