As part of the ongoing transition away from MyUTMB, HIM’s Forms Repository will be moving to OnBase, effective Sept. 9. The current Sharepoint directory listed below will be retired. If you have any questions or need assistance, please visit the HIM homepage or contact: HIM: formscommittee@utmb.eduInformation Services: IS.Ancillary@utmb.edu Consent Forms Search Expand All Collapse All 6500 Disclosure & Consent, Medical & Surgical Procedures - Generic 6500 - English6500 - Spanish 6501 Disclosure & Consent, Medical & Surgical Procedures - Anesthesia 6501 - English 6501 - Spanish 6501B Disclosure & Consent, Medical & Surgical Procedures - Sedation 6501B - English 6501B - Spanish 6501BB Disclosure & Consent, Medical & Surgical Procedures - Blocker Burn Unit Sedation 6501BB - English 6501BB - Spanish 6502 Disclosure & Consent, Medical & Surgical Procedures - Cardiovascular System 6502 - English 6502 - Spanish 6503 Disclosure & Consent, Medical & Surgical Procedures - Digestive System 6503 - English 6503 - Spanish 6504 Disclosure & Consent, Medical & Surgical Procedures - Ear Treatments 6504 - English 6504 - Spanish 6505 Disclosure & Consent, Medical & Surgical Procedures - Endocrine System 6505 - English 6505 - Spanish 6506 Disclosure & Consent, Medical & Surgical Procedures - Eye Treatments 6506 - English 6506 - Spanish 6508 Disclosure & Consent, Medical & Surgical Procedures - Hematic & Lymphatic 6508 - English 6508 - Spanish 6509 Disclosure & Consent, Medical & Surgical Procedures - Non Cosmetic Breast Surgery 6509 - English 6509 - Spanish 6510 Disclosure & Consent, Medical & Surgical Procedures - Male Genital 6510 - English 6510 - Spanish 6510A Disclosure & Consent, Medical & Surgical Procedures - Male Genital CIRCUMCISION 6510A - English 6510A - Spanish 6512 Disclosure & Consent, Medical & Surgical Procedures - Musculoskeletal System 6512 - English 6512 - Spanish 6513 Disclosure & Consent, Medical & Surgical Procedures - Nervous System 6513 - English 6513 - Spanish 6514 Disclosure & Consent, Medical & Surgical Procedures - Radiology 6514 - English 6514 - Spanish 6515 Disclosure & Consent, Medical & Surgical Procedures - Respiratory System 6515 - English 6515 - Spanish 6516 Disclosure & Consent, Medical & Surgical Procedures - Urinary System 6516 - English 6516 - Spanish 6516A Disclosure & Consent, Medical & Surgical Procedures - Urinary VALID 1 YR 6516A - English 6516A - Spanish 6518 Disclosure & Consent, Medical & Surgical Procedures - Radiation Therapy 6518 - English 6518 - Spanish 6519 Disclosure & Consent, Medical & Surgical Procedures - Endoscopic System 6519 - English 6519 - Spanish 6521 Disclosure & Consent, Medical & Surgical Procedures - Hysterectomy 6521 - English 6521 - Spanish 6522 Disclosure & Consent, Medical & Surgical Procedures - Maternity/Female Genital 6522 - English 6522 - Spanish 6522B Disclosure & Consent, Medical & Surgical Procedures - Maternity/Female Genital PREGNANCY 6522B - English 6522B - Spanish 6523 Disclosure & Consent, Medical & Surgical Procedures - Dermatologic Surgery 6523 - English 6523 - Spanish 6524 Disclosure & Consent, Medical & Surgical Procedures - Epilepsy Monitoring 6524 - English 6524 - Spanish 6525 Disclosure & Consent, Medical & Surgical Procedures - Kidney/Pancreas 6525 - English 6525 - Spanish 6527 Disclosure & Consent, Medical & Surgical Procedures - Genetic Amniocentesis 6527 - English 6527 - Spanish 6528 Disclosure & Consent, Medical & Surgical Procedures - Gastroenterology/Endo 6528 - English 6528 - Spanish 6529 Disclosure & Consent, Medical & Surgical Procedures - Pain Management 6529 - English 6529 - Spanish 6531 Disclosure & Consent, Medical & Surgical Procedures - Ophthalmology 6531 - English 6531 - Spanish 6532 Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology OR 6532 - English 6532 - Spanish 6533 Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Head/Neck OR 6533 - English 6533 - Spanish 6534 Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Sinus OR 6534 - English 6534 - Spanish 6535 Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Voice Proc 6535 - English 6535 - Spanish 6536 Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Ear Procedure 6536 - English 6536 - Spanish 6537 Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Head/Neck Clinic 6537 - English 6537 - Spanish 6538 Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Sinus Clinic 6538 - English 6538 - Spanish 6539 Disclosure & Consent, Medical & Surgical Procedures - Otolaryngology Voice Clinic 6539 - English 6539 - Spanish 6540 Disclosure & Consent, Medical & Surgical Procedures - Heart Transplant 6540 - English 6540 - Spanish 6541 Disclosure & Consent, Medical & Surgical Procedures - Pedi ENT 6541 - English 6541 - Spanish 6542 Disclosure & Consent, Medical & Surgical Procedures - Hyperbaric Oxygen Therapy 6542 - English 6542 - Spanish 6543 Disclosure & Consent, Medical & Surgical Procedures - Hyperbaric Oxygenation 6543 - English 6543 - Spanish 6544 Disclosure & Consent, Medical & Surgical Procedures - Pulmonary 6544 - English 6544 - Spanish 6545 Disclosure & Consent, Medical & Surgical Procedures - Liver Transplant 6545 - English 6545 - Spanish 6546 Disclosure & Consent, Medical & Surgical Procedures - Exercise Stress Test 6546 - English 6546 - Spanish 6547 Disclosure & Consent, Medical & Surgical Procedures - Ultrasound - MRI Guided Biopsy or Aspiration 6547 - English 6547 - Spanish 6548 Consent to Treatment with Psychoactive Medication 6548 - English 6548 - Spanish 6549 Disclosure & Consent, Medical & Surgical Procedures - Blood Transfusion 6549 - English 6549 - Spanish 6549A Disclosure & Consent Transfusion for Blood/Blood Components 1 yr Consent 6549A - English 6549A - Spanish 6549COVID Disclosure & Consent, Medical & Surgical Procedures - Transfusion of COVID-19 Convalescent Plasma 6549COVID - English 6549COVID - Spanish 6550 Disclosure & Consent, Medical & Surgical Procedures - Oral and Maxillofacial 6550 - English 6550 - Spanish 6551 Consent to Resuscitative Measures/Transfer 6551 - English 6551 - Spanish 6552 Disclosure & Consent, Medical & Surgical Procedures - Dobutamine Stress Echo 6552 - English 6552 - Spanish 6553 Disclosure & Consent, Medical & Surgical Procedures - Removal of Nexplanon 6553 - English 6553 - Spanish 6554 Disclosure & Consent, for Chemotherapy/Biotherapy Treatments 6554 - English 6554 - Spanish 6555 Disclosure & Consent, Medical & Surgical Procedures - Female Genital Operative Consent (No planned Hysterectomy) 6555 - English 6555 - Spanish 6556 Disclosure & Consent, Medical & Surgical Procedures - Female Genital Office Consent 6556 - English 6556 - Spanish 6556A Disclosure & Consent, Medical & Surgical Procedures - Female Genital IUD INSERTION 6556A - English 6556A - Spanish 6556B Disclosure & Consent, Medical & Surgical Procedures - Female Genital IUD REMOVAL 6556B - English 6556B - Spanish 6557 Disclosure & Consent, Medical & Surgical Procedures - Colorectal Surgery 6557 - English 6557 - Spanish 6558 Disclosure & Consent, Medical & Surgical Procedures - Pathology 6558 - English 6558 - Spanish 6559 Disclosure & Consent, Medical & Surgical Procedures - Nuclear Medicine 6559 - English 6559 - Spanish 6561 Consent Sensitive Examinations 6561-English 6561-Spanish 8094 Refusal/Consent for Blood Products 8094 - English 8094 - Spanish 8161 Consent and Authorization to Donate Tissue for Medical Research 8161 - English 8161 - Spanish Full E-forms Catalog(For Internal UTMB Use Only - Use Microsoft Edge for full functionality)