This customizable document, Blood/Blood Component Transfusion Consent Form, is taken from MCN Healthcare’s Outpatient Surgery and Ambulatory Services Policy and Procedure Manual. For more than 20 years, MCN has been the health care industry’s leading provider of policy and procedure templates, forms, competencies and other compliance tools.

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 Blood/Blood Component Transfusion Consent Form:

	BLOOD/BLOOD COMPONENT TRANSFUSION CONSENT FORM My physician has informed me that I need or may need during treatment a transfusion of whole blood and/or fresh frozen plasma, packed cells, platelets or cryoprecipitate in the interest of my health and proper medical care. My physician has described to me the risks and benefits of receiving transfusions. These risks exist despite the fact that the blood has been carefully tested. The alternatives to transfusions, including the risks and consequences of not receiving this therapy, have been explained to me. I have had the opportunity to...
Second excerpt:
	...o derivados de plasma, para beneficio de mi salud y cuidado médico. Mi doctor me ha explicado los riesgos y beneficios en recibir transfusión o transfusiones de sangre. Estos riesgos existen a pesar de que la sangre ha sido cuidadosamente examinada. Las alternativas a las transfusiones, incluyendo riesgos y consecuencias al no recibir este tratamiento, me han sido explicadas. Se me ha concedido la oportunidad de hacer preguntas, y estoy de acuerdo en recibir la transfusión o...