The following is a general consent for the treatment of services rendered by Brownsville Advanced OB/GYN, which may include diagnostic, radiology, laboratory procedures, and the administration of medication. (I understand that if I am pregnant and do not have a physician, I can contact Dr. Fernando Ramirez to provide me with information about services and treatment.) Should you require additional treatment and procedures, we will discuss said treatment and options with you, and obtain consent for further treatment before proceeding.
I, knowing that I am in need of examination or treatment, do hereby voluntarily consent to such procedures and medical care provided to me by Brownsville Advanced OB/GYN or their designee as necessary. I further acknowledge that the practice of medicine is not an exact science and no guarantees have been made to me as to the result of treatments or examinations by Fernando Ramirez, M.D., P.A., or its representatives.
I provide consent to be tested for COVID-19. I understand this is an effort in response to the COVID-19 Pandemic. I understand that I must continue clinical care with a Primary Care Physician or Obstetrician and Gynecologist. I attest that I have slowly and carefully read and understood the information and policies of Brownsville Advanced Ob/Gyn, available at www.ramirezobgyn.com, and agree to adhere to them. I further understand that if I commit fraud, we are required to report such instances to the proper authorities.
I understand that I have the right to be tested or have treatment elsewhere, with another doctor, or at another facility providing testing/treatment services. I understand that I also have the right to not be tested at all. I acknowledge that an inherent risk of exposure to COVID-19 exists in any public place where people are present. However, I am making this decision to get tested for COVID-19 freely and voluntarily. By clicking herein, and voluntarily presenting myself for testing, I am assuming all risks related to exposure to COVID-19 and agree not to hold Brownsville Advanced OB/GYN, Dr. Fernando Ramirez, M.D., P.A., his employees, or agents liable for any illness or injury. I am insisting that Brownsville Advanced OB/GYN, Dr. Fernando Ramirez, M.D., P.A., or their designee test me for COVID-19, as I believe it is in my best interest and the best interest of my future child (if currently pregnant). I knowingly, freely, and voluntarily accept these terms, conditions, and inherent risks by clicking, “I agree to terms & conditions,” herein.