2006 Code of Virginia § 54.1-2971 - Informed consent for treatment of breast tumor; paragraphs required in form

54.1-2971. Informed consent for treatment of breast tumor; paragraphsrequired in form.

Before a physician operates on a patient for a tumor of the breast, a consentform shall have been executed which includes the following:

"CONSENTFORTREATMENTOFBREASTTUMOR"
Signoption(a)oroption(b),oroption(a)andoption(b)
(a)IauthorizeDr.........toperforma
BreastBiopsy...............................................................
side(rightand/orleft)
.............................................................................
Patient'sorotherauthorizedperson'ssignature
(b)IfitisdeterminedthatIhaveamalignanttumorinmybreastorother
breastabnormalityrequiringsurgery,thenIauthorizeDr.........to
performsuchoperationsorprocedures,includingbreastremoval,whichare
deemednecessary.
Procedure:
.............................................................................
.............................................................................
Patient'sorotherauthorizedperson'ssignature

(1984, c. 88, 54-325.2:2; 1985, c. 328; 1988, c. 765.)