手术术前告知曁知情同意书
Pre-Srugery Notice and Informed Consent Form
现代医学整形美容外科已有高度发展，这是社会文明进步的表现。追求美是无可非议的。但医学是一门经验科学，总有不尽完善的地方，整形美容手术仍有一些难以解决的问题，受
术者应当给予以注意。请详细阅读下列条款：
一、本同意书由手术医师与受术者或其他家属共同协商签署，履行相应的责任和义务。
二、美容手术医生必会尽最大努力完成手术，但由于每个人审美观点不同和自身条件的限制，只能是在原有基础上塑形变化，不一定完全满足各自的完美要求，对手术效果应当有正确
客观的认识。
三、美容手术同其他任何手术一样，都具有一定的风险性，如麻醉意外，药物过敏，手术意外，术后并发症等均有可能发生，受术者要有风险共担的意识和一定的心理承受能力。
四、美容手术均为手工操作，同时每个人的机体组织情况均不相同，术后可能出现效果不佳或并发症（如硬结、肿胀、疼痛、出血、感染等）若出现上述情况及并发症，本院可协助就近治
疗和处理，但手术费、医疗费由受术者承担。
五、受术者应严格遵守医嘱（含口头医嘱、医院病历本或术后注意事项）治疗，若出现红、肿、热、痛等异常情况，应立即来本院就诊，以便及时处理，否则，造成的后果由受术者本人负
责。
六、受术者手术部位肿胀恢复期，因年龄、体质、凝血功能，手术部位不同而异。
七、受术者若患有精神异常、药物过敏、瘢痕增生成重大疾病等不宜手术的病患，术前应如实告知医生，若隐瞒病史，由此出现的并发症，本院概不负责。
八、受术者美容手术前后必须照相，相片存入医院病例资料，本院有权用于教学、发表学术论文，作学术交流、医学资料刊用等，但不可用作商业广告使用。
九、姓名、通讯地址及电话必须真实有效，否则因此而延误治疗、护理所造成的后果由受术者自己负责。
十、月经期、妊娠期、哺乳期不宜手术。
十一、手术者如有特殊隐私要求，请事先说明，手术医生有保护受术者隐私的义务。
十二、本协议未尽亊宜，应按常规医疗文件或比照医学惯例执行。
Modern medical plastic surgery has gained high development, which is a manifestation of social civilization progress.It is above reproach f
or human to pursue perfection. Nevertheless, medical science is a sort of science concerning experience, so there are inevitably some blemi
shes. Similarly, couples of intractable problem exist in plastic surgeries. Thus, special attention shall be given and patients shall read
carefully the following provisions:
I.This Consent Form is entered and signed collectively by and between the surgeon and the patient or his/her family dependents, who sh
all perform their responsibilities and obligations respectively.
II.The surgeons will exhaust their endeavors to accomplish the surgeries, but due to different aesthetic conceptions and limitation by
the physical conditions of different patients, we are only able to shape or beautify the customers on the original basis, instead of sat
isfying the perfect requirements of customers completely. The patients shall have a correct and objective understanding on the effect of
surgeries.
III.Like any other operations, cosmetic surgeries have certain risks, such as anesthetic, drug allergy, surgery accidents and postoperative
complications. The patients shall be aware of sharing risks and have appropriate psychological endurance.
IV.As all cosmetic surgeries are operated manually and organization condition of everybody’s organism is different from one and another, i
t is possible that poor effect or complications occur(as scleroma, swelling, pain, hemorrhage, infection etc) after operation. If so,we
may assist to carry out cure and treatment,provided that operation fee and medical charge are born by the patients.
V.The patient shall receive treatment by strictly doctors’advice(including oral advices,notes on medical records or cautions after opratio
n).In the event of swell,fever or opain,the patient shall come to this hospital for treatment immediately.Otherwise,all results so induc
ed shall be responsible at the patient's own part.
VI.With respect to swell part at surgical part,recovery period for each patient varies with his or her age,physical condition and blood coa
gulation ability as well as surgical part.
VII.If the patients have psychological problems,drug allergy, proliferation of scar or some major diseases which hinder surgery, they s
hall inform the doctors as it is. Providing the complication occurs due to concealing of medical record, this hospital bears no responsi
bilities.
VIII.The patients must take photos before and after cosmetic surgeries, The photos are to be filed into medical record data in the hospital,
Which has the righe to urilize them in teaching, release of ancademic papers, academic commuications and publication with medical matet
ials. However, they are nor allowed to be used as commercial advertisements.
IX.The name, address and telephone number of the patients shall be true and correct. Otherwise, results caused by delay of cure and tre
