Assent Form (Informal Decision Making) printable pdf download

Assent Form (Informal Decision Making)

HERMITAGE

DENTAL

CLINIC

Patient Name

__________________________________

Date of Birth

__________________________________

Name of Clinician

__________________________________

Assent procedure ( Informal Decision Making ) is followed when a patient is reasonably assumed

to lack the capacity to consent.

Capacity

Capacity is the ability to understand the nature and consequences of a decision in the context of available choices at the

time the decision is to be made. Dentists should presume that adults have the capacity to consent to or refuse a proposed

treatment unless it can be established that they lack that capacity. Each assessment of an individual’s capacity should relate

to a speciﬁc decision at a speciﬁc time.

In certain circumstances specialist assessment may be required, but in general the assessment consists of conveying

information to the patient, discussing it with him/ her to gauge his/her understanding and then asking questions about the

salient points to see if he/she has grasped them.

Tick where appropriate

Yes

Assessing Capacity (C Test):

Does the patient comprehend and retain treatment information?

Does the patient believe that information?

Does the patient weigh that information, balancing risks and

needs, to arrive at a choice?

Is the patient a ward of court?

What special measures were considered to facilitate the assessment of capacity?

Using language / communication aids to facilitate understanding

Using time and location where the person feels most relaxed and at ease

Need for consultation with others, such as a Psychologist or Speech Therapist?

Comment

________________________________________________________________________

Assent Form (Informal Decision Making)