Informed Consent - Cardiac

Please note: The Medical Board of Australia has published Guidelines: Sexual boundaries in the doctor-patient relationship. These guidelines, which came into effect on 12 December 2018, provide guidance on establishing and maintaining sexual boundaries in the doctor-patient relationship. To support hospitals/individual health practitioners/patients to comply with these guidelines, our Informed Consent forms and Patient Information sheets for procedures requiring intimate examinations, have been updated in the relevant surgical areas, indicated below by an (*).

Two separate additional student consent forms (adult and child/young person), indicated below by an (**), are to be used for patients to complete if the procedure is yet to occur and prior consent has been undertaken on the previous version of informed consent forms, or if the procedure consent form does not have a student section included.

Adult  |  Child/Young Person

A - D |  E - H |  I - L |  M - P |  Q - Z

Title File SizeVersion
A Additional Student Consent **

2.7 MB

2

Adenosine Stress Cardiac MRI Study is superseded by Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent   
Alcohol Septal Ablation Consent * 686 KB 3
Alcohol Septal Ablation (2011) is superseded by Alcohol Septal Ablation Consent * (2024)   
Anaesthetic Patient Information Sheets  
Aortic Surgery

277 KB

6

Atrial Septal Defect Repair (2011) is superseded by Transcatheter Atrial Septal Defect Repair Consent *   
Atrial Fibrillation (AF) Ablation Consent * 681 KB 3
Atrial Fibrillation (AF) Ablation (2011) is superseded (2024) by Atrial Fibrillation (AF) Ablation Consent * (2024)   
Blood transfusion consent and refusal forms are now located under Blood specialty.   
Cardiac Biopsy Consent * 688 KB 1
Cardiac Biopsy (Femoral Vein Approach) (2011) is superseded by Cardiac Biopsy Consent * (2024)   
Cardiac Biopsy (Internal Jugular Vein Approach) (2011) is superseded by Cardiac Biopsy Consent * (2024)   
Cardiac Catheter Ablation (2011) is superseded by Electrophysiology Study (EPS) with or without Cardiac Catheter Ablation Consent * (2024)   
Cardiac Device Removal Consent 548 KB 3
Cardiopulmonary Exercise Stress Test

114 KB

4

Cardioversion Consent *

637 KB

3

Coronary Angiogram Consent * 654 KB 6
Coronary Angioplasty and Stenting Consent *

874 KB

7

Coronary Angiogram and/or Angioplasty and Stenting Consent 340 KB 2
Coronary Artery Bypass Graft &/or Valve Surgery

317 KB

2

Electrophysiology Study (EPS) with or without Cardiac Catheter Ablation Consent * 737 KB 1
Electrophysiology Study (EPS) (2011) is superseded by Electrophysiology Study (EPS) with or without Cardiac Catheter Ablation Consent * (2024)   
Exercise Stress Test *

618 KB

6

Generic Consent - Cardiac *

744 KB

8

Heart Transplant

78 KB

3

Implantable Cardiac Defibrillator (ICD) Insertion Consent * 699 KB 7
Implantable Cardiac Defibrillator (ICD) (2011) is superseded by Implantable Cardiac Defibrillator (ICD) Insertion Consent * (2024)   
Iron Infusion
This form is now located on the Miscellaneous and Medicine speciality page
  
Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent 604 KB 1
Mitral Transcatheter Edge-to-Edge Repair Consent 796 KB 1
Myocardial Perfusion Scan Consent* 637 KB 1
Myocardial Perfusion Scan is superseded by Myocardial Perfusion Scan Consent*   
Pacemaker Insertion Consent * 681 KB 7
Pacemaker (2011) is superseded  by Pacemaker Insertion Consent * (2024)   
Patent Ductus Arteriosus Repair

131 KB

3

Patent Foramen Ovale Repair

479 KB

4

Percutaneous Aortic Balloon Valvuloplasty Consent * 819 KB 5
Percutaneous Aortic Balloon Valvuloplasty (2011) is superseded by Percutaneous Aortic Balloon Valvuloplasty Consent * (2024)   
Percutaneous Mitral Balloon Valvuloplasty Consent * 819 KB 5
Percutaneous Mitral Balloon Valvuloplasty (2011) is supersded by Percutaneous Mitral Balloon Valvuloplasty Consent * (2024)   
Right Heart Catheter Consent * 768 KB 1
Right Heart Catheter (Femoral Vein Approach) (2011) is superseded by Right Heart Catheter Consent * (2024)   
Right Heart Catheter (Internal Jugular Vein Approach) (2011) is superseded by Right Heart Catheter Consent * (2024)   
Removal of Cardiac Device (2011) is superseded by Cardiac Device Removal Consent (2024)   
Stress Echocardiogram Consent *

712 KB

5

Stress Echocardiogram is superseded (2024) by Stress Echocardiogram Consent *   
Tilt Test

83 KB

2

Transcatheter Atrial Septal Defect Repair Consent 889 KB 1
Transcatheter Heart Valve Implant Consent * 763 KB 2
Transcatheter Aortic Valve Implant (Transfemoral Approach) is superseded by Transcatheter Heart Valve Implant Consent *   
Transcathether Ventricular Septal Defect Repair Consent 728 KB 1
Transoesophageal Echocardiogram (TOE) Consent * 727 KB 5
Transoesophageal Echocardiogram (TOE) (2011) is superseded  by Transoesophageal Echocardiogram (TOE) Consent * (2024)   
Ventricular Septal Defect Repair (2011) is superseded by Transcathether Ventricular Septal Defect Repair Consent (2024)   
Ventricular Assist Device (VAD)

86 KB

1

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Child/Young Person | Adult

Title File SizeVersion
A Additional Student Consent - Child/Young Person **

2.5 MB

2

About Your Child's Anaesthetic
This patient information sheet is now located under Anaesthetics speciality.
  
Atrial Septal Defect (2011) is superseded by Transcatheter Atrial Septal Defect Repair Consent (2024)   
Atrioseptostomy 3.08 MB 2
Blood transfusion consent and refusal forms are now located under Blood specialty.   
Cardiac Biopsy Consent * 688 KB 1
Cardiac Catheterisation 153 KB 3
Electrophysiology Study (EPS) with or without Cardiac Catheter Ablation Consent * 737 KB 1
Exercise Stress Test *

618 KB

6

Implantable Cardiac Defibrillator (ICD) Insertion Consent * 699 KB 7
Iron Infusion
This form is now located on the Miscellaneous and Medicine speciality page 
  
Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent 604 KB 1
Myocardial Perfusion Scan Consent* 637 KB 1
Pacemaker Insertion Consent * 681 KB 7
Patent Ductus Arteriosus

163 KB

3

Percutaneous Aortic Balloon Valvuloplasty Consent * 819 KB 5
Percutaneous Mitral Balloon Valvuloplasty Consent * 819 KB 5
Right Heart Catheter Consent * 768 KB 1
Tetralogy of Fallot

162 KB

3

Transcatheter Atrial Septal Defect Repair Consent 889 KB 1
Transcathether Ventricular Septal Defect Repair Consent  728 KB 1
Transoesophageal Echocardiogram (TOE) Consent * 727 KB 5
Ventricular Septal Defect (2011) is superseded by Transcathether Ventricular Septal Defect Repair Consent (2024)   

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Last updated: 19 July 2024