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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.

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Index Procedure List File Size
AA 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 149 KB
 Angiogram &/-Plasty / Stenting 209 KB
 Angioplasty 209 KB
 Antenatal Ultrasound Guided Procedure 37 KB
 Arterial Stent 209 KB
 Arteriogram 149 KB
 Arthrogram 165 KB
 Aspiration 148 KB
 Aspiration - Breast * 80 KB
 Aspiration - Chest 162 KB
Index Procedure List File Size
BBarium Enema 40 KB
 Biliary Drain Insertion 86 KB
 Biliary Stent Insertion 86 KB
 Biliscopin 100 KB
 Biopsy - Chest 152 KB
 Biopsy - Other 149 KB
 Biopsy - Superficial * 137 KB
 Biopsy - TRUS 108 KB
  Blood transfusion consent and refusal forms are now located under Blood specialty.            
 Bone Biopsy 135 KB
 Breast Aspiration * 669 KB
 Breast Biopsy * 112 KB

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Index Procedure List File Size
CCardiac CT 80 KB
 Cardiac MRI - Adenosine 114 KB
 Cardiac MRI - Dobutamine 148 KB
 Carotid Stent 157 KB
 Catheter Check with IV Contrast 64 KB
 Catheter Check without IV Contrast 41 KB
 Celiac Plexus Block 72 KB
 Central Line Check 64 KB
 Central Line Insertion 119 KB
 Central Vascular Access Device Insertion 119 KB
 Cerebral Vasospasm Treatment 135 KB
  Cerebral Thrombolysis / Clot Retrieval
This form is now superseded by Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic
6.5 MB
 Cerebrospinal Fluid (CSF) Shunt Patency Scan Consent * 3.2 MB
 Chemoemobolisation 113 KB
 Chest Aspiration 162 KB
 Chest Biopsy 152 KB
 Chest Drain 143 KB
 Cholangiogram - CT 100 KB
 Cholangiogram - Percutaneous 86 KB
 Chorionic Villus Sampling (CVS) 160 KB
  Clot Retrieval - Cerebral
This form is now superseded by Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic
6.5 MB
 CO2 Angiogram 72 KB
 Coiling - Cerebral Aneurysm 140 KB
 Conduitogram 24 KB
 Contrast Enema * 48 KB
 Contrast Injection - Iodinated 48 KB
 Contrast Injection - Iodinated (Renal Impaired Patient ONLY) 116 KB
 Contrast Injection - MRI 41 KB
 Contrast Injection - MRI (Renal Impaired Patient ONLY) 83 KB
 CSF Flow Study 110 KB
 CT Cardiac 80 KB
 CT Cholangiogram 100 KB
 CT Colonoscopy 40 KB
 CT Scan * 378 KB
 Cystogram * 284 KB

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Index Procedure List File Size
DDacrocystogram 40 KB
 Defaecogram * 278 KB
 Discogram 85 KB
 Dobutamine Stress Study MRI                                                                                  148 KB
 Drainage 148 KB

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Index Procedure List File Size
EEmbolisation - Cerebral Coiling 140 KB
 Embolisation - CNS 102 KB
 Embolisation - Other 146 KB
 Embolisation Uterine Artery (EUA) 112 KB
 Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic Stroke 6.5 MB
 Enteroclysis 33 KB
 Enema 40 KB
 Epidural Injection 131 KB

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Index Procedure List File Size
FFacet Joint Injection 131 KB
 Fetal Ultrasound - Nuchal Translucency 76 KB
 Fetal Ultrasound - Obstetric 76 KB
 Fine Needle Aspiration (FNA) 149 KB
 Fistulogram (AV) 103 KB
 Fistulogram / Sinogram *                                                                                      356 KB
GGastrostomy40 KB
 Gastrostomy Check127 KB
 Gastrografin Enema *41 KB
 Generic Medical Imaging Consent224 KB
 Generic Nuclear Medicine Consent75 KB
 Generic Ultrasound Guided Antenatal Procedure *3.2 MB 
 Groin Biopsy *112 KB

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Index Procedure List File Size
HHickman Catheter Insertion 119 KB
 Hickman Catheter Check 64 KB
 Hydrodilatation 141 KB
 Hysterosalpingogram (HSG) *                                                                           556 KB

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Index Procedure List File Size
IInterCostal Catheter (ICC) Insertion 143 KB
 Interventional Procedure - Any Interventional Procedure Requiring Consent 72 KB
 Intrathecal Chemotherapy Lumbar Puncture 109 KB
 Intrauterine Blood Transfusion 37 KB
 Intravenous Pyelogram (IVP) 66 KB
 Iodinated Contrast 48 KB
 Iodinated Contrast (Renal Impaired Patients ONLY)               116 KB
 Iodine-131 Therapy for Hyperthyroidism 101 KB
 IVC Filter Removal 109 KB
 IVC Filter Insertion 128 KB

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Index Procedure List File Size
JJoint Injections - Other                                                                                         141 KB
LLiver Biopsy 102 KB
 Liver Biopsy Under Imaging 149 KB
 Liver Biopsy - Transjugular 111 KB
 Lumbar Puncture (LP) 131 KB
 Lumbar Puncture for Intrathecal Chemotherapy 109 KB
 Lung Biopsy 152 KB

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Index Procedure List File File
MMammary Ductogram * 603 KB
 Medical Imaging Generic Consent 72 KB
 Micturating CystoUrethrogram (MCU) 40 KB
 MRI Cardiac Stress Perfusion 114 KB
 MRI Contrast Injection 41 KB
 MRI Contrast Injection (Renal Impaired Patients ONLY)                                          83 KB
 MRI Dobutamine Stress Study 148 KB
 MRI Scan 57 KB
 Myelogram 146 KB
 Myocardial Perfusion Scan 86 KB

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Index Procedure List File Size
NNasogastric Tube Check 41 KB
 Nephrostogram 65 KB
 Nephrostomy 168 KB
 Nerve Root Injection 131 KB
 Nuchal Translucency Ultrasound *                                                                            438 KB
 Nuclear Medicine Generic Consent 75 KB
OObstetric Ultrasound * 488 KB

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Index Procedure List File Size
PPain Block                                                                                                                          131 KB
 Parathyroid Sampling 151 KB
 PEG 127 KB
 PEG Check 41 KB
 Pelvic Ultrasound - Transvaginal 38 KB
 Percutaneous Transhepatic Cholangiogram (PTC) 86 KB
 Percutaneous Transluminal Angioplasty (PTA) 209 KB
 Peripherally Inserted Central Catheter (PICC) 119 KB
 Peripheral Thrombolysis 126 KB
 Permacath Insertion 119 KB
 Petrosal Sinus Sampling 151 KB
 Phosphorus-32 Therapy 82 KB
 Pleural Tap 162 KB
 Portacath Insertion 119 KB
 Portacathogram 64 KB
 Prostate Biopsy 108 KB

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Index Procedure List File Size
RRadiation and Medical Imaging 33 KB
 Radio Frequency Ablation (RFA) 186 KB
 Renal Biopsy 149 KB
 Renal Renin Sampling 130 KB
SSaline Sonogram * 101 KB
 Samarium-153 EDTMP Bone Therapy 81 KB
 Selective Internal Radiation Therapy (SIRT) 112 KB
 Selective Termination 37 KB
 Sialogram 45 KB
 Sinogram / Fistulogram *                                                                                                              32 KB
 Small Bowel Series / Follow Through 46 KB
 Small Bowel Enema 33 KB
 Spinal Injection 131 KB
 Strontium-89 Bone Therapy 81 KB
 Superficial Biopsy 402 KB
 Swallow / Meal 46 KB

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Index Procedure List File Name
TThoracentesis (Pleural Tap) 162 KB
  Thrombolysis - Cerebral
This form is now superseded by Endovascular Thrombectomy and/or Thrombolysis for Acute Ischaemic
6.5 MB
 Thrombolysis - Peripheral (Catheter Directed) 126 KB
 Thyroid Biopsy 112 KB
 Transcatheter Arterial ChemoEmbolisation (TACE) 113 KB
 Transjugular Intrahepatic Portcaval Shunt (TIPS) 112 KB
 Transjugular Liver Biopsy 111 KB
 Transvaginal Ultrasound 3.6 MB
 Trans Rectal Ultrasound (TRUS) Biopsy 108 MB
 T Tube Cholangiogram 41 KB

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IndexProcedure ListFile Size
UUltrasound Scan *                                                                                                                 496 KB
 Ultrasound Scan - Nuchal Translucency76 KB
 Ultrasound Scan - Obstetric73 KB
 Ureteric Stent168 KB
 Urethrogram *                335 KB
VVascath Insertion119 KB
 Vasospasm (Cerebral) Treatment135 KB
 Venogram103 KB
 Vertebroplasty86 KB
 V/Q Scan in Pregnancy82 KB
YYttrium-90 Colloid Therapy for Joint Pain and Swelling89 KB
Last updated: 11 November 2021