As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Outpatient Surgery and Ambulatory Services Policy and Procedure Manual includes this customizable template, Authorization and Consent Form - Photograph and Publication. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more.

MCN provides more than 80 health care specific policy and procedure manuals for Acute Care Hospitals, Ambulatory Care, Behavioral Health, Home Health, Physician Practice, and Long Term Care. MCN’s policy and procedure manuals focus on the latest healthcare "hot topic" issues related to patient safety and prevention of medical healthcare errors.

Here is some sample content from Authorization and Consent Form - Photograph and Publication:

	AUTHORIZATION AND CONSENT PHOTOGRAPH AND PUBLICATION The undersigned hereby authorizes Facility and the attending physician to photograph or permit other persons to photograph patient's name while under the care of the above-named facility. The undersigned agrees that the above-named facility and the attending physician may use and permit other persons to use the negatives or prints prepared from such photographs for such purposes and in such manner as either may deem appropriate. The undersigned agrees the photographs may be used for purposes including, but not limited to, dissemination...
Second excerpt:
	...of the photography/filming may be accomplished in any manner and that such use is subject only to the following limitations: The undersigned has entered into this agreement in order to assist scientific treatment, educational, public relations and charitable goals and hereby waives any right to compensations for such uses by reasons of the foregoing authorization, and the undersigned and his/her successors or assignees hereby hold the above-named facility and the attending physician...