Patient Photo Consent Form Template & Key Considerations for Dermatologists

Question
Hi,
I'm a dermatologist, I need to formulate a consent form for my patients to sign before I take photographs of the lesion they have in their skin.
I need a sample so I find out what points to clarify in the consent form .
Many Thanks


Answer
Dear Dr.Al-Ali,
Just as you have a Hippa form for your patients medical information you can simply procduce a form:
                Authorization to be photographed

I_______________________ (patient) do hereby give my express authorizaton and consent to Dr. Fayza Al-Ali, MD to photograph for the purpose of the diagnosis and treatment of my dermatolgical lesions located _____________________.

Signed:___________________________   Date:_______________

Witness:__________________________

I would keep it simple just cover the facts.  Be sure to give a copy to the patient and keep a copy in the file.  The Hippa form should cover sharing the photographs (if necessary) as long as the patient indicates who the records can be shared with (patient supplies the name).

I do hope this helps.

Diane