Patient Informed Consent Form

A doctor-patient consent agreement records the patient's informed consent for a medical procedure, examination, or course of treatment. In Bangladesh medical consent is regulated by the Bangladesh Medical & Dental Council (BM&DC) Code of Medical Ethics 2010 and the general principles of the Contract Act, 1872. Informed consent requires disclosure of the diagnosis, the proposed procedure and reasonable alternatives, material risks and expected outcomes, the anaesthesia plan (if any), and the estimated cost. The patient must be competent, must consent voluntarily without duress, and consent to a specific procedure — not a blanket authorisation. For minors, spouse consent for family-planning procedures, and unconscious emergency patients, special rules apply.

Stamp & registrationA doctor-patient consent form does not require stamp duty or registration to be legally effective. It is typically issued on hospital letterhead. Retention is mandatory under BM&DC record-keeping guidelines (usually 3-5 years for outpatient, 10 years for major surgery). For any consent that also creates a payment obligation above Tk. 50,000, hospitals sometimes attach a separate service agreement on Tk. 300 non-judicial stamp.

What this agreement typically contains

Hospital / clinic name, address, BM&DC registration
Attending doctor name, BM&DC registration number, department
Patient full name, age, sex, NID / birth certificate, contact
Guardian / next-of-kin details (mandatory for minors and incapacitated patients)
Diagnosis and reason for the proposed procedure
Proposed procedure or treatment (specific, not blanket)
Material risks, complications, and expected outcomes disclosed
Anaesthesia type and its risks (if applicable)
Estimated cost and payment terms
Patient / guardian signature, doctor signature, witness signature

Create this agreement now

Frequently asked questions

Who can give consent for a minor patient?: For patients under 18, consent is given by the natural guardian — usually the father under Muslim law and the natural guardian under the Guardians and Wards Act, 1890 for others. If both parents are alive and available, joint consent is safer for elective procedures. If parents are unavailable in an emergency, the doctor may proceed under the emergency doctrine and Section 88 of the Penal Code (act done in good faith to prevent harm) — but must document the emergency and inform guardians as soon as possible. Court-appointed guardians follow their custody order.
Can consent be withdrawn after signing?: Yes. A patient can withdraw consent at any time before the procedure begins, and the doctor must respect that decision even at the last moment. Once the procedure has started, withdrawal may be impractical (e.g. mid-surgery) but the doctor should stop where clinically safe. Withdrawn consent should be recorded in writing along with a clinical note that the patient was informed of the consequences of stopping. Refusal or withdrawal does not by itself absolve the doctor of duty of care — the patient must still be given continued advice and referral.
What happens if a procedure goes beyond the consented scope?: The doctor commits medical trespass unless the extension was necessary in the immediate interest of the patient during an ongoing procedure and was reasonable in light of professional standards (Section 88 of the Penal Code, 1860 protects good-faith acts). BM&DC ethics rules require re-consenting where practicable — for example, if a diagnostic laparoscopy reveals a condition needing treatment, the surgeon typically closes, obtains fresh consent, and re-operates. Extending scope without consent exposes the doctor to complaint before the BM&DC and to a civil claim in damages.

Other contracts in this category

What this agreement typically contains

Hospital / clinic name, address, BM&DC registration

Attending doctor name, BM&DC registration number, department

Patient full name, age, sex, NID / birth certificate, contact

Guardian / next-of-kin details (mandatory for minors and incapacitated patients)

Diagnosis and reason for the proposed procedure

Proposed procedure or treatment (specific, not blanket)

Material risks, complications, and expected outcomes disclosed

Anaesthesia type and its risks (if applicable)

Estimated cost and payment terms

Patient / guardian signature, doctor signature, witness signature

Frequently asked questions

Who can give consent for a minor patient?

For patients under 18, consent is given by the natural guardian — usually the father under Muslim law and the natural guardian under the Guardians and Wards Act, 1890 for others. If both parents are alive and available, joint consent is safer for elective procedures. If parents are unavailable in an emergency, the doctor may proceed under the emergency doctrine and Section 88 of the Penal Code (act done in good faith to prevent harm) — but must document the emergency and inform guardians as soon as possible. Court-appointed guardians follow their custody order.

Can consent be withdrawn after signing?

Yes. A patient can withdraw consent at any time before the procedure begins, and the doctor must respect that decision even at the last moment. Once the procedure has started, withdrawal may be impractical (e.g. mid-surgery) but the doctor should stop where clinically safe. Withdrawn consent should be recorded in writing along with a clinical note that the patient was informed of the consequences of stopping. Refusal or withdrawal does not by itself absolve the doctor of duty of care — the patient must still be given continued advice and referral.

What happens if a procedure goes beyond the consented scope?

The doctor commits medical trespass unless the extension was necessary in the immediate interest of the patient during an ongoing procedure and was reasonable in light of professional standards (Section 88 of the Penal Code, 1860 protects good-faith acts). BM&DC ethics rules require re-consenting where practicable — for example, if a diagnostic laparoscopy reveals a condition needing treatment, the surgeon typically closes, obtains fresh consent, and re-operates. Extending scope without consent exposes the doctor to complaint before the BM&DC and to a civil claim in damages.