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Surgery Consent form below Minimize File Preview Review one of them and identify the five requirements within that  consent form; explain where and how each element is noted within the  actual form itself. Then, analyze the purpose for such consent forms from both the patient’s and organization’s viewpoints. Your paper should be two to three pages in length, excluding the  title and reference pages; include at least two scholarly sources, in  addition to the text; and be written in APA format.   I have had the opportunity to have my questions answered to my satisfaction.  □ “Language Line” SM  used for interpretation. I authorize my physicians and Martin Memorial to disclose health informati on related to  this treatment or procedure to any friend or family member who has accompanied me or  who  is  waiting  for  me,  even  if  I  am  competent  or  available,  with  the  exception  of  the   following: _______________________________________________ _______________________ ________________________________________ ________________________________  Patient/Authorized Surrogate Or Proxy Signature  Date/Time ________________________________________ __________________________ Witness Signature  Date/Time I  certify  that  I  have  explained  the  nature,  purpose,  benefits,  risks,  complications,  and  alternatives   of   the   proposed   procedure   to   the   patient   or   the   patient’s   legal   representative.  I  have  answered  all  questions  fully,  and  I  believe  that  the  patient/legal  representative  fully  understands  what  I  have  explained.  I  further  certify  that  I  have  validated  the  procedure/site  and  side,  and  that  the  correct  procedure  site  has  been   marked, if indicated, prior to the procedure being performed. __________________________________________ __________________________ Practitioner Signature  Date/Time MARTIN MEMORIAL HEALTH SYSTEMS STUART, FL SURGERY CONSENT RM056 Rev 11/00 2/01, 6/03, 10/05, 2/06, 3/07, 5/07, 4/08, 01/09; 7/11; 1/12; 5/12 G/Consent Forms/surgical consent 056 REVISIONS MADE TO THIS CONSENT MUST BE APPROVED BY RISK  MANAGEMENT.