An informed patient consent for blood component(s) transfusion must be obtained prior to a transfusion (Form #6549).
- A new consent must be obtained for each admission for inpatients.
- A new consent must be obtained at least once every 12 months for outpatients.
- For emergent situations, follow IHOP - 09.03.17 - Consent - Overview and Basic Requirements.
- For individuals with Limited English Proficiency (LEP) or who are hearing impaired, refer to IHOP – 09.03.35 – Patient Centered Communication.
- UTMB Language Assistance Office, 409-747-2121; if you cannot access the Language Assistance Office, contact the UTMB paging operator 409-772-4004.
For Transfusion Consents Frequently Asked Questions, refer to Consent FAQ.
Consent for Blood Products
6549 - Transfusion Consent Form (English)
6549SP - Transfusion Consent Form (Spanish)
Refusal for Blood Products
Consent Resources
See IHOP - 09.03.17 - Consent - Overview and Basic Requirements for additional consent details.
For Health Information Management Department (HIM), visit UTMB Health Information Management website for information.
All Consent Forms (6500 Series) can be found here.
