Beacon Womens Center. abortion clinic- Consent to outpatient surgery form states:
“I understand that the purpose of an abortion is to end a pregnancy. I understand that my first trimester abortion consists of stretching open the mouth of the uterus (cervix) and removing the contents of my uterus-with surgical instruments and gentle suction. As a result of surgical procedures there may be material risks of: infection, allergic reaction, disfiguring scars, severe loss of blood, loss of function of a limb or organ, paralysis, paraplegia or quadriplegia, brain damage, cardiac arrest or death. In addition to these material risks, there may be other possible risks involved in the procedure including but not limited to: perforation, cervical tear, formation of blood clots in the uterus, hemorrhage, blood transfusions, DIC: the inability to clot blood which may be fatal, Fistula formation: An opening between bowel, bladder, ureter, vagina, and/or skin, emboli: clots that might travel to other parts of my body and be fatal, incomplete abortion, missed abortion, cervical incompetency, emotional distress, infection, possible need for immediate surgery or other additional surgery which might include a hysterectomy, laparascopy, and laparotomy, and ectopic pregnancy”
This document also details the extreme risks of anesthesia and states that
“No guarantees of assurance have been made to me concerning the results of this procedure.”
The patient is told to sign her name, but the name of the doctor performing the abortion is not included or revealed on this form.
Provided by Life Dynamics
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