Fluorescein angiography consent form https://www.opsweb.org/forums/posts.aspx?topic=378617 Sun, 19 Jul 2026 15:51:04 GMT Thu, 13 Sep 2012 12:23:54 GMT Copyright © 2012 Ophthalmic Photographers' Society Fluorescein angiography consent form https://www.opsweb.org/forums/posts.aspx?topic=378617 https://www.opsweb.org/forums/posts.aspx?topic=378617 Hi All,

We have been using a consent form that is used hospital wide within the UNC system; not written for fluorescein angiography.  So, we are looking to create a form specifically for IVFA and ICG tests.  Can anyone out there attach or send me a copy of theirs?

Thanks,

Rona

Rona Lyn Esquejo-Leon, CRA

Ophthalmic Imaging Specialist

UNC Eye Clinic, Chapel Hill

Kittner Eye Center

resquejo@unch.unc.edu

]]> Tue, 6 Mar 2012 19:09:11 GMT https://www.opsweb.org/forums/posts.aspx?topic=378621 https://www.opsweb.org/forums/posts.aspx?topic=378621 Rona,

This is what we use at the clinic. It is fluorescein specific but could easily be adapted for ICG as well.

It is 3 pages in length because the type is LARGE for our visually challenged patients.

Good luck,

bob

]]> Tue, 6 Mar 2012 19:22:47 GMT https://www.opsweb.org/forums/posts.aspx?topic=378643 https://www.opsweb.org/forums/posts.aspx?topic=378643 Tue, 6 Mar 2012 20:06:09 GMT https://www.opsweb.org/forums/posts.aspx?topic=465254 https://www.opsweb.org/forums/posts.aspx?topic=465254 Tue, 11 Sep 2012 21:41:02 GMT RE: https://www.opsweb.org/forums/posts.aspx?topic=466307 https://www.opsweb.org/forums/posts.aspx?topic=466307 N. Brugnoni said:
Bob - do you consent ICG patients? We are actually going to the extent of doing a pregnancy test prior to ICG procedure but not FA per our nurse..I am trying to look further into this..


Nikki,

We do not do ICG's so consent for that procedure in our clinic is moot.

We also do not do any invasive procedures involving dyes on any female who is or might think she may be pregnant. If the patient is not sure we will not do the procedure.

We always err on the side of caution when doing these

Hope this helps.

bob

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