Informed Consent Form for Cybernetic Procedures

by **Admin** Tue Jul 14, 2015 5:57 pm

Falleen Medical Contracts
Cybernetic Surgical Mobile Unit
Chief of Medicine
Ryurik Van D`Arc
Director of Surgical Operations.

Informed Consent Form for Cybernetic Procedures.

You have the right as a patient to be informed about the risks and possible
complications involved. The purpose of this "Informed Consent Form is to
verify you have received this information and have given your consent to the
procedure.

Risks:
Risks associated with the operation procedure are:
* Each cybernetic operation lasts for 24 hours.

* Unconsciousness:
You will be sedated and unconscious for the entire duration.

*Theft:
All your equipment must be removed from your person..leave your items back on your ship or facility prior to entering the operating room. Any equipment on your person will be "dropped" to the floor.

*Failure:
There is a chance that this operation may fail and you may have to undergo a
second operation.

* Revived:
After the operation you will be revived and only have 1 (one) HP.

***However, Be assured that FMC/CSMU Staff have taken all steps necessary to safeguard your person and your property while you are in our care.FMC/CSMU will also provide you with full healing in a Bacta Tank immediately after your operation included in the fee.

Outcomes:
There are three outcomes of any cybernetic surgery.

*Successful: The operation is successful and the implant is installed without
incident. A successfully installed implant can be later uninstalled through
similar surgery.

*Unsuccessful: The operation is unsuccessful. No harm is done and you are free to attempt an instillation of the implant again in a subsequent surgery.

**Critical Failure: The implant is damaged and becomes a "Faulty Cybernetic"
It will be fused to the user, making it impossible to remove (at this time).

There are a few "activities" that can interrupt the the operation procedure:

Arrest: Arrest of the Patient or the Surgeon will immediately abort the
operation and revive the patient.

Death: Death of the Patient or the Surgeon will immediately abort the
operation and revive the patient, unless it is the patient that has died.

Patient Declaration.
1/ I acknowledge that Falleen Medical Contracts and The Cybernetic Surgical
Mobile Unit, have informed me about the procedure and answered all my
specific questions and concerns about this procedure.

2/ I acknowledge that I am aware of the possible risks involved and that I am
aware of the chances of success and critical failure specific to my
circumstances.

3/ I understand that no warranty or guarantee has been made to me that the operation will be a success.

4/ I realise that this procedure rely's on a "Random Roll". That while all precautions are taken by the medical team as per Equipment,Skills of Staff and Quality of Products, there can be no blame for any failure attached to the Surgeon, nor any refund,compensation or benefit gained by dispute, should circumstances be detrimental to me.

5/ I realise that although unlikely that should a critical failure occur,the faulty
cybernetic will be fused to my person and there is no way at this time to remove it.

6/ In signing this "Informed Consent Form for Cybernetic Surgery, I am stating
that I have READ the contents of this document in addition to those on the
Cybernetic Operations Rules Page:
( Click Link Here )
......... V .........
( http://www.swcombine.com/rules/?Cybernetic_Operations ).

I fully understand and accept the terms and the possible risks,complications
and benefits that can result from a cybernetic surgery.

My decision to undertake cybernetic surgery has been my own and has been
made without duress or inducement of any kind.

I understand that at any stage before the actual commencement of the
operation, I have the option to change my mind about having the procedure.

Name: ......................................................

Date: .......................................................(OOC)

Implant: ...................................................

Surgeon: ...................................................

Email: .....................................................
(So a copy can be sent to you)