CCHI Mini-Glossary Project Glossary #6 Subject: General Consent (Sight Translation) Language: English
# English Your Translation into: Explanation or acceptable substitution in English 1. General consent
2. General consent for care
3. Treatment consent
4. Acknowledgement form
5. I certify that…
6. I have read and fully understand the above statements 7. I consent to … Syn. I give consent to… I grant consent to…
8. I agree to…
9. Fully and voluntarily
10 By signing below… .
11 I understand and . acknowledge the following… 12 Currently in effect .
Certification Commission for Healthcare Interpreters (CCHI) 1725 I Street, NW – Suite 300 / Washington DC 20006 www.cchicertification.org / [email protected] 1 CCHI Mini-Glossary Project Glossary #6, Subject: General Consent Language: English
13 Hereby .
14 Your signature . indicates full acceptance and acknowledgement of each applicable paragraph marked by an (X). 15 Personal . representative
16 Authorized . representative
17 Custodian or Legal . Guardian
18 Witness .
19 Relationship to patient .
20 Self (n) .
21 The consent will . remain fully effective until it is revoked. 22 This consent is . effective for as long as… 23 In writing .
24 I have been given… . Syn. I have been provided… I have received… 25 I have been advised . that…
Certification Commission for Healthcare Interpreters (CCHI) 1725 I Street, NW – Suite 300 / Washington DC 20006 www.cchicertification.org / [email protected] 2 CCHI Mini-Glossary Project Glossary #6, Subject: General Consent Language: English
26 You have the right to… .
27 I authorize… .
28 At any time .
29 I understand that I am . responsible for…
30 Surgical, medical or . diagnostic procedure
31 Risks and hazards . involved
32 Recommended . treatment
33 Suggested treatment .
34 Appropriate treatment .
35 Necessary treatment .
36 Reasonable and . necessary
37 Purpose, potential . risks, and benefits of any test ordered for you 38 Medical examinations, . testing and treatment
39 Invasive or . interventional procedures
Certification Commission for Healthcare Interpreters (CCHI) 1725 I Street, NW – Suite 300 / Washington DC 20006 www.cchicertification.org / [email protected] 3 CCHI Mini-Glossary Project Glossary #6, Subject: General Consent Language: English
40 As deemed necessary . Syn. May deem necessary 41 Prior to .
42 To renter treatment . Syn. To perform treatment To administer treatment 43 To obtain treatment . Syn. To undergo treatment 44 To discontinue services .
45 Refusal to grant such . consent will not jeopardize my right to… 46 Permission for . treatment
47 Conditions of care .
48 I agree to the terms . specified.
49 I am authorized to . execute this form.
50 To facilitate my care .
Certification Commission for Healthcare Interpreters (CCHI) 1725 I Street, NW – Suite 300 / Washington DC 20006 www.cchicertification.org / [email protected] 4