Operation Consent Form and Information | Union Hospital

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Operation Consent Form

Consent for Anaesthesia

Consent for Surgery

Doctor's Declaration (For Termination of Pregnancy only)

Operation Information

Anaesthesia

Breast Surgery

Cardiology

Dental

Endoscopy

Eye

General Surgery

Haematology

Medical Imaging

Neurosurgery

Obstetrics & Gynaecology

Orthopaedics

Otorhinolaryngology

Paediatrics

Plastic Surgery

Thoracic

Urology

Others

Anaesthesia
Epidural Analgesia for Labour Pain AN-06e V5	General Anaesthesia AN-01e V5	Intravenous Sedation AN-05e V5
Local Anaesthesia AN-07e V4	Monitored Anaesthetic Care (MAC) AN-03e V4	Spinal Anaesthesia AN-02e V4

Breast Surgery
Axillary Dissection BS-05e V5	Breast Core Biopsy BS-03e V5	Excision of Breast Lump BS-07e V6
Microdochectomy BS-09e V4	Modified Radical Mastectomy (MRM) BS-04e V5	Pedicle Transverse Rectus Abdominious Muscle (TRAM) Flap Reconstruction BS-11e V4
Sentinel Lymph Node Biopsy/ Dissection BS-02e V5	Simple Mastectomy BS-08e V4	Wide Local Excision of Breast Tumour BS-01e V6
Wire Localization Excision BS-10e V4

Cardiology
Catheter Ablation of Atrial Fibrillation HEC-16e V3	Catheter Ablation HEC-15e V3	Coronary Angiogram +/- Percutaneous Coronary Intervention HEC-20e V2
Coronary Artery Bypass Graft Surgery ± Endoscopic Vein Harvesting OH-01e V4	Direct Current Cardioversion HEC-05e V4	Electrophysiology Study(EPS) HEC-14e V3
Valve Replacement OH-02e V4	Left Atrial Appendage Occlusion (LAAO) HEC-17e V2	Percutaneous Coronary Intervention (PCI) HEC-01e V4
Permanent Cardiac Pacemaker HEC-06e V4	Septal Defect Repair OH-03e V4	Temporary Cardiac Pacing HEC-04e V4
Tilt Table Test HEC-11e V4	Transcatheter Aortic Valve Implantation Procedure (TAVI) HEC-18e V2	Transcatheter Mitral Valve Repair HEC-19e V3
Transcatheter Renal Denervation HEC-10e V4	Transesophageal Echocardiography (TEE) HEC-12e V4

Dental
Bleaching DT-13e V4	Bridge DT-09e V4	Crown DT-08e V5
Dental Implant DT-05e V6	Denture DT-10e V5	Endodontic Treatment DT-12e V4
Extraction DT-07e V5	Filling DT-04e V4	Fixed Appliance Therapy DT-02e V4
Laminate Veneer DT-15e V4	Orthodontic Mini-Screw DT-17e V4	Orthodontic Treatment DT-03e V5
Periodontal Disease DT-14e V4	Scaling DT-06e V4

Endoscopy
Capsule Endoscopy ED-08e V4	Colonoscopy ED-02e V5	Endoscopic Retrograde Cholangio-Pancreatography (ERCP) ED-05e V4
Endoscopic Submucosal Dissection (ESD) ED-09e V4	Endoscopic Ultrasound (EUS) ED-07e V4	Oesophago-Gastro-Duodenoscopy(OGD) ED-01e V5
Sigmoidoscopy ED-03e V4	Balloon-Assisted Enteroscopy ED-10e V1

Eye
Chalazion-Incision & Curettage EYE-04e V5	Corneal Biopsy EYE-07e V4	Corneal Scrape / Culture EYE-08e V4
Corneal Transplantation EYE-02e V4	Correction of Ptosis (Drooping Eyelid) EYE-12e V4	Electrocautery (High Temperature) EYE-21e V3
Entropion / Lids Corrective Surgery EYE-11e V4	Excision of Eyelid & Ocular Tumor EYE-14e V5	Fundal Fluorescent Angiogram / Fundus Fluorescein Angiography (FFA) EYE-05e V4
Insertion of Lacrimal Plug EYE-17e V4	Intravitreal Injection of Anti-Vascular Endothelial Growth Factors Drug EYE-10e V5	Laser Surgery of the Eye EYE-06e V5
Pars Plana Vitrectomy EYE-13e V4	Phacoemusification + Intraocular Lens Implantation EYE-01e V5	Pterygium Excision EYE-03e V5
Removal of Ocular Lithiasis EYE-20e V3	Retinal Re-attachment Surgeries (Vitrectomy / Scleral buckling / Pneumatic retinopexy) EYE-16e V4	Squint Correction EYE-22e V3
Subconjunctival Injection EYE-09e V6	Surgical Correction of Trichiasis (Ingrowing Eyelashes) EYE-15e V5	Syringing / Probing of Tear Duct EYE-19e V4

General Surgery
Abdominal Tapping GS-16e V4	Abscess Incision and Drainage GS-17e V4	Adrenalectomy (Open/Laparoscopic) GS-35e V3
Anal Fistulotomy GS-15e V4	Appendectomy(Open/Laparoscopic) GS-01e V5	Cauterization of Warts GS-29e V3
Cholecystectomy (Open/Laparoscopic) GS-04e V6	Circumcision GS-06e V5	Colectomy (Open/ Laparoscopic) GS-11e V4
Examination under Anaesthesia GS-31e V3	Excision of Nodules or Small Lumps GS-08e V5	Fine Needle Aspiration GS-19e V5
Gastrectomy(Open/Laparoscopic) GS-14e V4	Haemorrhoid Banding GS-34e V3	Haemorrhoidectomy GS-02e V5
Hemi-thyroidectomy/Total Thyroidectomy GS-05e V6	Hepatectomy (Open/Laparoscopic) GS-10e V5	Hernia Repair(Open/Laparoscopic) GS-03e V5
Injection of Haemorrhoid GS-30e V3	Insertion of Chest Drain GS-18e V3	Laparoscopic AP Resection GS-33e V3
Laparoscopic Anterior Resection of Rectum GS-13e V4	Laparoscopy GS-28e V3	Laparotomy GS-32e V3
Liver Biopsy GS-27e V3	Oesophagectomy(Open/Laparoscopic) GS-38e V3	Pancreaticoduodenectomy (Whipple operation) GS-12e V4
Parathyroidectomy GS-36e V3	Percutaneous Endoscopic Gastrostomy (PEG) GS-41e V3	Renal Biopsy GS-21e V4
Sclerotherapy Injection GS-26e V3	Splenectomy(Open/Laparoscopic) GS-39e V3	Suturing GS-24e V3
Varicose Veins -Endovenous Radiofrequency Ablation GS-07e V6	Venesection GS-23e V4	Wedge Excision of Ingrown Toenail GS-09e V5

Haematology
Bone Marrow Aspiration and / or Biopsy HM-01e V4

Medical Imaging
Barium Enema MEI-13e V1	Barium Follow Through MEI-14e V1	Barium Meal and Follow Through MEI-16e V1
Barium Meal MEI-15e V1	Barium Swallow and Meal MEI-18e V1	Barium Swallow MEI-17e V1
Catheter Angiography / Angiogram MEI-02e V4	Cerebral Angiogram MEI-12e V2	Hysterosalpingogram (HSG) MEI-19e V1
Intravenous Urography (IVU) MEI-26e V1	Loopogram MEI-27e V1	Myelogram MEI-28e V2
Percutaneous Biopsy MEI-05e V4	Percutaneous Drainage of Abscesses or Fluid Collections MEI-09e V4	Percutaneous Fine Needle Aspiration (FNA) Biopsy MEI-04e V4
Percutaneous Nephrostomy (PCN) MEI-03e V4	Percutaneous Transhepatic Cholangiogram(PTC) / Percutaneous Transhepatic Biliary Drainage(PTBD) ± Stent Insertion MEI-07e V4	Radiofrequency Ablation for Liver Tumors MEI-08e V4
Retrograde Pyelogram (Unilateral_Bilateral) MEI-29e V1	Sialogram (Unilateral_Bilateral) MEI-30e V1	Sinogram MEI-31e V1
Small Bowel Enema MEI-32e V1	T-Tube Cholangiogram MEI-33e V1	Tomosynthesis/ Stereotactic-Guided Vaccuum-Assisted Breast Biopsy MEI-11e V5
Transarterial Chemoembolization (TACE) MEI-01e V4	Transcatheter Embolotherapy (TCE) for Internal Bleeding MEI-10e V4	Urethrogram MEI-34e V1
Videofluoroscopic Swallowing Study (VFSS) MEI-35e V1	Voiding Cystogram MEI-36e V1	Water Soluble Contrast Enema MEI-20e V1
Water Soluble Contrast Follow Through MEI-22e V1	Water Soluble Contrast Meal and Follow Through MEI-23e V1	Water Soluble Contrast Meal MEI-21e V1
Water Soluble Contrast Swallow and Meal MEI-25e V1	Water Soluble Contrast Swallow MEI-24e V1	Contrast-enhanced Voiding Urosonography MEI-37e V1

Neurosurgery
Anterior Cervical Discectomy and Fusion (Cage + Plate) NRO-01e V4	Craniotomy NRO-02e V4

Obstetrics & Gynaecology
Abdominal Hysterectomy ONG-06e V4	Caesarean Section OBS-01e V5	Cervical Polypectomy GNY-13e V3
Colposcopy + Loop Electro-Surgical Excisional Procedure (LEEP)/(LLETZ) ONG-09e V6	Colposcopy ± Biopsy GNY-14e V3	Dilatation and Curettage of Uterus (D&C) / Suction ONG-15e V3
Drug Induced Abortion ONG-13e V4	Endometrial Biopsy ONG-14e V3	Hysteroscopic Endometrial Ablation/Resection GNY-15e V3
Hysteroscopic Excision of Fibroids / Polyps ONG-08e V7	Hysteroscopy, Dilation & Curettage (D&C) ONG-03e V5	Intrauterine Contraceptive Device (IUCD) I&OL (O&G-01e) V3
Laparoscopic Assisted Vaginal Hysterectomy (LAVH) / Laparoscopic Assisted Subtotal Hysterectomy (LASH) GNY-17e V3	Laparoscopic Hysterectomy ONG-02e V5	Laparoscopic Salpingectomy GNY-16e V3
Laparoscopic Sterilization ONG-07e V4	Marsupialization of Bartholin Cyst GNY-18e V3	Myomectomy(Open/Laparoscopic/Hysteroscopic) ONG-01e V5
Ovarian Cystectomy/Salpingo-Oophorectomy(Laparoscopic/Open) GNY-19e V4	Postpartum Sterilization GNY-20e V3	Tension Free Vaginal Tape – Obturator (TVT-O)/a> ONG-05e V4
Termination of Pregnancy GNY-05e V6	Vaginal Hysterectomy ONG-12e V5	Wertheim’s Hysterectomy ONG-11e V4

Orthopaedics
Above or Below-Knee Amputation OP-14e V4	Ankle Fracture Fixation Surgeries OP-15e V4	Anterior Cruciate Ligament (ACL) Reconstruction OP-05e V5
Anterior Spinal Fusion OP-08e V5	Arthroscopic Meniscal Surgery OP-04e V5	Arthroscopy of Ankle OP-18e V4
Arthroscopy of Knee OP-22e V3	Arthroscopy of Shoulder OP-23e V3	Aspiration of Joint Fluid OP-17e V3
Calcaneal Fracture Fixation OP-13e V4	Carpal Tunnel Release OP-10e V4	Closed Reduction OP-32e V2
Excision of Ganglion Cyst OP-06e V4	External Fixation OP-31e V2	Hallus Valgus Corrective Surgery OP-24e V3
Hip Hemiarthroplasty OP-11e V4	Internal Fixation of Hip Fracture OP-12e V4	Intra-articular/Tendon Injection OP-19e V3
Kyphoplasty/ Vertebroplasty OP-30e V2	Laminectomy OP-25e V3	Lumbar Spine Discectomy OP-07e V4
Open Reduction and Internal Fixation OP-01e V4	Platelet-Rich Plasma (PRP) Injection OP-29e V3	Posterior Decompression and/or Spinal Fusion OP-09e V4
Release of De Quervain’s Disease OP-20e V4	Release of Subsungual Haematoma OP-21e V3	Repair of Achilles Tendon OP-28e V3
Total Hip Replacement OP-16e V4	Total Knee Replacement OP-03e V5	Trigger Finger Release (Stenosing Tenosynovitis) OP-02e V5

Otorhinolaryngology
Adenoidectomy ENT-05e V4	Closed Reduction of Fractured Nose ENT-27e V3	Cochlear Implant Insertion ENT-28e V3
Excision of Neck Mass ENT-19e V3	Functional Endoscopic Sinus Surgery (FESS) ENT-06e V4	Intratympanic Injection ENT-20e V4
Mastoidectomy ENT-18e V5	Micro-Laryngoscopy ENT-31e V3	Myringotomy ± Ventilation Tube Insertion ENT-03e V4
Nasal Biopsy ENT-21e V4	Naso-Laryngoscopy ENT-32e V3	Parotidectomy ENT-15e V4
Preauricular Sinus Excision ENT-14e V4	Radiofrequency Turbinate Reduction ENT-25e V4	Removal of Foreign Body (Throat) ENT-22e V4
Removal of Vocal Cord Polyp ENT-08e V4	Septoplasty / Submucosal Resection of Septum (SMR) ENT-13e V6	Stapedectomy ENT-29e V3
Submandibular Gland Resection ENT-23e V4	Tongue-Tie Release / Tie Cutting ENT-26e V3	Tonsillectomy ENT-01e V4
Turbinectomy ENT-09e V5	Tympanoplasty ENT-07e V4	Uvulopalatopharyngoplasty (UPPP) / Laser-assisted uvuloplasty (LAUP) ENT-24e V4

Paediatrics
Circumcision in Children PED-07e V4	Correction of Chordee PED-02e V4	Inguinal Hernia Repair in Children PED-08e V4
Laparoscopic Pyeloplasty PED-05e V4	Orchidopexy in Children PED-06e V4	Suprapubic Catheterization PED-03e V4
Vesicoureteral Reflux (VUR) in Children PED-10e V4

Plastic Surgery
Augmentation Rhinoplasty PS-05e V5	Blepharoplasty PS-06e V5	Breast Augmentation PS-04e V4
Excision of Mole / Naevus PS-01e V5	Lower Lid Blepharoplasty PS-02e V5	Ultrasound-assisted Liposuction PS-03e V5

Thoracic
Bronchoscopy TRC-10e V4	Bullectomy TRC-12e V2	Mediastinoscopy_Mediastinotomy TRC-11e V2
NUSS Procedure TRC-06e V3	Pleural Biopsy TRC-08e V4	Pleural Drainage TRC-09e V4
Pleurodesis TRC-07e V4	Thoracoscopic Sympathectomy TRC-01e V4	Thoracotomy + Lobectomy TRC-05e V4
Tracheobronchial Stenting TRC-13e V2	Video Assisted Thoracoscopic Surgery - Lobectomy TRC-02e V4	Video Assisted Thoracoscopic Surgery - Pleurodesis TRC-03e V4
Video Assisted Thoracoscopic Surgery – Wedge Excision of Lung TRC-04e V4	Endobronchial Ultrasound (EBUS) TRC-14e V1

Urology
Cystoscopy UR-01e V4	Extracorporeal Shock Wave Lithotripsy (ESWL) UR-16e V4	Insertion of Tenckhoff Catheter UR-18e V3
Insertion of Ureteric Stent UR-03e V4	Laparoscopic Nephrectomy (Radical/ Partial) UR-05e V4	Orchidectomy UR-20e V3
Radical Prostatectomy UR-04e V4	Rezūm Therapy for Benign Prostatic Hyperplasia (BPH) UR-22e V2	Transperineal Ultrasound Guided Prostate Needle Biopsy UR-21e V2
Transrectal Ultrasound Guided Prostate Biopsy (TRUS) UR-06e V4	Transurethral Resection of Bladder Tumor (TURBT) UR-11e V4	Transurethral Resection of Prostate (TURP)/ Transurethral Electrovaporization of Prostate (TUEVP) UR-02e V5
Ureterscopy (URS) UR-15e V3	Varicocelectomy UR-19e V3	Vasectomy UR-10e V4

Others
General Information on Blood Transfusion BT-01e V7