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RULE §601.5Disclosure and Consent Form for Radiation Therapy

The Texas Medical Disclosure Panel adopts the following form to be used by a physician or health care provider to inform a patient or person authorized to consent for a patient of the possible risks and hazards involved in the radiation therapy named in the form. This form is to be used in lieu of the general disclosure and consent form adopted in §601.4(a) of this title (relating to Disclosure and Consent Form) for disclosure and consent relating to only radiation therapy procedures. If a surgical or anesthetic procedure is required in combination with a radiation therapy procedure, the general disclosure and consent form as adopted in §601.4(a) of this title and the form adopted in this section shall be used. The general disclosure and consent form shall be used for the surgical or anesthetic procedure and the radiation therapy disclosure and consent form shall be used for the radiation therapy procedure. Providers shall have the form available in both English and Spanish language versions. Both versions are available from the Department of State Health Services.

  (1) English form.

Attached Graphic

  (2) Spanish form.

Attached Graphic

Source Note: The provisions of this §601.5 adopted to be effective October 3, 1995, 20 TexReg 7486; amended to be effective November 28, 2004, 29 TexReg 10780; amended to be effective October 16, 2005, 30 TexReg 6435

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