Informed Consent - Medical Imaging

Adult |  Child/Young Person

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.

A |  C |  D |  E |   |  G |  H |   I |  J |  K  |   |  M |  N |  O |  P |  Q  |  R |  S |  T |  U |   |  W  |  Y |  Z

Index Procedure list
AA Additional Student Consent (PDF 2797 kB) **
 Amniocentesis/Chorionic Villus Sampling (PDF 3202 kB) *
 Anaesthetic (PDF 415 kB)
 Anorectal Physiology and Endoanal Ultrasound (PDF 5064 kB) *
 Angiogram Consent (PDF 837 kB)*
 Antenatal Ultrasound Guided Procedure (PDF 3203 kB)
 Arthrogram (Image-Guided) Consent (PDF 636 kB)
 Aspiration/Drainage (Image-Guided) Consent (PDF 1627 kB) *
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BBarium Enema (PDF 483 kB)
 Biopsy (Image-Guided) Consent (PDF 580 kB) *
  Blood transfusion consent and refusal forms are now located under Blood specialty.           
 Breast Imaging (PDF 787 kB) *
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C 
 Carotid Artery Angioplasty and Stenting Consent (PDF 541 kB)
 Catheter Check with Iodinated Contrast (PDF 377 kB)
 Central Vascular Access Device (CVAD) Insertion Consent (PDF 658 kB)*
 Cerebral Vasospasm Treatment Consent (PDF 748 kB)
 Cerebrospinal Fluid (CSF) Shunt Patency Scan Consent (PDF 3276 kB) *
 Cholangiogram (Percutaneous Transhepatic) with or without Biliary Drain/Stent Consent (PDF 817 kB)
 Chorionic Villus Sampling (CVS) (PDF 3202 kB)
 Computed Tomography (CT) Cardiac Scan Consent (PDF 596 kB)
 Computed Tomography (CT) Cholangiogram with Biliscopin Consent (PDF 917 kB)
 Computed Tomography (CT) Colonography (PDF 1163 kB)
 Computed Tomography (CT) Myelogram Consent (PDF 698 kB)
 Computed Tomography (CT) Scan Consent (PDF 606 kB)
 Computed Tomography (CT) Scan (PDF 455 kB)
 Computed Tomography (CT) Scan During Pregnancy Consent (PDF 635 kB)
 Computed Tomography (CT) Scan with Rectal Contrast (PDF 619 kB)
 Conduitogram (PDF 409 kB)
 Contrast Enema (PDF 483 kB) *
 Cerebrospinal Fluid (CSF) Flow Study Consent (PDF 648 kB)
 Cystogram / Urethrogram / Micturating Cysto-Urethrogram (MCU) (PDF 788 kB)*
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IInferior Vena Cava (IVC) Filter Insertion Consent (PDF 1290 kB)
 Inferior Vena Cava (IVC) Filter Removal Consent (PDF 1010 kB)
 Intercostal Catheter (ICC) Insertion Consent (PDF 678 kB)
 Interventional Procedure - Any Interventional Procedure Requiring Consent (PDF 223 kB)
 Iodine-131 Therapy Consent (PDF 558 kB)
 Ionising Radiation During Pregnancy Consent (PDF 531 kB)
 Ionising Radiation During Pregnancy (PDF 359 kB)
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JJoint Injection/Nerve Root Injection/Hydrodilatation (Image-Guided) Consent (PDF 852 kB)
LLumbar Puncture (Image-Guided) Consent (PDF 721 kB)
 Lumbar Puncture  (Intrathecal Chemotherapy) Consent (PDF 778 kB)
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MMagnetic Resonance Enterography (MRE) (Small Bowel Study) (PDF 613 kB)
 Magnetic Resonance Imaging (MRI) Cardiac Stress Study Consent (PDF 603 kB)
 Magnetic Resonance Imaging (MRI) Scan Consent (PDF 637 kB)
 Magnetic Resonance Imaging (MRI) Scan (PDF 472 kB)
 Magnetic Resonance Imaging (MRI) Scan of Liver with Primovist® (PDF 446 kB)
 Magnetic Resonance Imaging (MRI) Scan with a MRI-Conditional Pacemaker/Implantable Cardioverter Defibrillator (ICD) Consent (PDF 813 kB) *
 Mammary Ductogram (PDF 602 kB) *
 Medical Imaging and Radiation (PDF 734 kB)
 Medical Imaging Generic Consent (PDF 612 kB) *
 Myocardial Perfusion Scan Consent (PDF 636 kB) *
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NNephrostogram (PDF 318 kB)
 Nephrostomy with or without Ureteric Stent Insertion Consent (PDF 845 kB)
 Nuchal Translucency Ultrasound (PDF 437 kB) *                                                                           
 Nuclear Medicine Scan Generic Consent (PDF 706 kB)
OObstetric Ultrasound (PDF 487 kB) *
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PPelvic Ultrasound - Transvaginal (PDF 495 kB)
 Peripherally Inserted Central Catheter (PICC) Consent (PDF 1131 kB)
 Positron Emission Tomography (PET) Scan  (PDF 414 kB)
 Port Removal Consent (PDF 522 kB)*
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RRadio-guided Occult Lesion Localisation using Iodine-125 Seeds (ROLLIS) Consent (PDF 638 kB) *
SSaline Sonogram (PDF 556 kB) *
 Sclerotherapy Consent (PDF 638 kB)*
 Selective Internal Radiation Therapy (SIRT) Consent (PDF 580 kB)
 Sialogram (PDF 391 kB) *
 Sinogram / Fistulogram (PDF 411 kB) *                                                                                                             
 Small Bowel Series / Follow Through (PDF 367 kB)
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TThermal Ablation Consent (PDF 505 kB)
 Thoracentesis Consent (PDF 755 kB)
 Thrombolysis (Catheter Directed) Consent (PDF 735 kB) *
 Trans-Arterial Chemo-Embolisation (TACE) Consent (PDF 716 kB) *
 Transjugular Intrahepatic Portosystemic Shunt (TIPS) Consent (PDF 1277 kB)
 Transjugular Liver Biopsy Consent  (PDF 542 kB)
 Transvaginal Ultrasound (PDF 3644 kB)
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UUltrasound Scan (PDF 495 kB)
 Ultrasound Scan - Nuchal Translucency (PDF 437 kB)
 Ultrasound Scan - Obstetric (PDF 487 kB)
VVenogram Consent (PDF 624 kB)
 Venous Sampling Consent  (PDF 641 kB)
 Vertebroplasty Consent  (PDF 474 kB)
 Ventilation-Perfusion (VQ) Scan During Pregnancy Consent (PDF 519 kB) *
YYttrium-90 Colloid Therapy Consent (PDF 588 kB) *

Last updated: 5 April 2024