Pregnancy Waiver Form - Web are you pregnant or any chance you may be: Web a form for patients who wish to waive a pregnancy test and assume the risk of exposure to abdomen and pelvis. Committee on quality management and. Acknowledge that surgery/anesthesia may cause congenital abnormalities in fetal development and /. Web statement on pregnancy testing prior to anesthesia and surgery. Web create a pregnancy waiver form to confirm that a patient is not pregnant before medical treatment. Q i am not pregnant _____ (patient initials) pregnancy. Web there are risks with radiation exposure in pregnancy, therefore we ask you to sign a pregnancy waiver (see below). _____ yes _____ no the exam your doctor has ordered uses ionizing radiation which.
_____ yes _____ no the exam your doctor has ordered uses ionizing radiation which. Web a form for patients who wish to waive a pregnancy test and assume the risk of exposure to abdomen and pelvis. Acknowledge that surgery/anesthesia may cause congenital abnormalities in fetal development and /. Web statement on pregnancy testing prior to anesthesia and surgery. Web are you pregnant or any chance you may be: Committee on quality management and. Web there are risks with radiation exposure in pregnancy, therefore we ask you to sign a pregnancy waiver (see below). Q i am not pregnant _____ (patient initials) pregnancy. Web create a pregnancy waiver form to confirm that a patient is not pregnant before medical treatment.