Infusion Therapy Consent
Updated: September 29, 2019
This document is intended to serve as informed consent for your Intravenous (IV) Infusion Therapy as ordered by the physician at iVee.
- 1The procedure involves inserting a needle into a vein and injecting the prescribed solution.
- 2Alternatives to intravenous therapy are oral supplementation and / or dietary and lifestyle changes.
- 3Risks of intravenous therapy include but not limited to:
Occasionally: Discomfort, bruising and pain at the site of injection.
Rarely: Inflammation of the vein used for injection, phlebitis, metabolic disturbances, and injury.
Extremely Rare: Severe allergic reaction, anaphylaxis, infection, cardiac arrest and death.
- 4Benefits of intravenous therapy include:
Injectables are not affected by stomach, or intestinal absorption problems.
Total amount of infusion is available to the tissues.
Nutrients are forced into cells by means of a high concentration gradient.
Higher doses of nutrients can be given than possible by mouth without intestinal irritation.
- 1I understand the information provided on this form and agree to the all statements made above.
- 2Intravenous (IV) Infusion Therapy has been adequately explained to me by my nurse and/or physician.
- 3I have received all the information and explanation I desire concerning the procedure.
- 4I authorize and consent to the performance of Intravenous (IV) Infusion Therapy.
- 5I release Dr. James Simonson, iVee, and all the medical staff from all liabilities for any complications or damages associated with my Intravenous (IV) Infusion Therapy.
If you have any questions about the Infusion Therapy Consent above, please contact us here.