Healthcare & Wellness

Cataract Surgery Informed Consent

Informed consent for phacoemulsification cataract extraction with intraocular lens (IOL) implantation. Covers indications, phacoemulsification technique, IOL options (monofocal, toric, multifocal, extended depth of focus), procedure-specific risks (posterior capsule rupture, vitreous loss, endophthalmitis, TASS, retinal detachment, corneal edema, elevated IOP), alternatives, and post-operative expectations. Patient signer.

📄 1 signer📅 30-day expiry🏷 Healthcare & Wellness🔖 single-signer, consent, healthcare, ophthalmology, cataract, phacoemulsification, iol, surgical-consent

About this template

The Cataract Surgery Informed Consent is a ready-to-use healthcare & wellness template you can send for signature in minutes. It is written for 1 signer (patient) and, by default, expires 30 days after it is sent if left unsigned. It covers consent, healthcare, ophthalmology, cataract, phacoemulsification, iol. Like every Abundera Sign template it is a convenience draft structured for ESIGN Act and UETA compliance, not a substitute for legal advice. Each signed copy is sealed with PAdES-LTA digital signatures, dual RFC 3161 timestamps, and a tamper-evident evidence package in WORM storage.

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# Cataract Surgery Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Date:** ___________ **Surgeon / Ophthalmologist:** ___________ **Surgery Center / Hospital:** ___________ **Patient Name:** ___________ ("Patient") **Date of Birth:** ___________ **Medical Record Number (if applicable):** ___________ **Eye to Be Operated:** ___________ --- ## 1. Description of the Procedure (a) A **cataract** is a clouding of the eye's natural crystalline lens that causes progressive blurring of vision, glare, halos around lights, difficulty reading, and reduced color contrast. Cataracts develop most commonly with age, but can also result from trauma, certain medications (corticosteroids), metabolic conditions (diabetes), or radiation. (b) **Phacoemulsification** is the standard surgical technique for cataract removal. The surgeon makes one or two small incisions (typically 2–3 mm) at the edge of the cornea, opens the front of the lens capsule (capsulorhexis), and uses an ultrasonic probe to break the cataract into fragments (emulsification) and vacuum them out. The posterior capsule of the natural lens is left intact as a support for the intraocular lens. (c) **Femtosecond laser-assisted cataract surgery (FLACS):** ___________ When FLACS is used, a femtosecond laser creates the corneal incisions, performs the capsulorhexis, and pre-fragments the lens before phacoemulsification, potentially improving precision of some steps. (d) **Intraocular lens (IOL) implantation:** After the cataract is removed, an artificial IOL is folded and inserted through the small incision into the lens capsule bag. The IOL unfolds and centers within the eye, replacing the optical function of the natural lens. **Planned IOL Type:** ___________ **Targeted Post-operative Refraction:** ___________ (e) The procedure typically takes 15–30 minutes under topical anesthesia (eye drops) ± mild intravenous sedation. General anesthesia is rarely required. --- ## 2. Indications

Fields (18)

consent date
date · required
surgeon name
text · required
facility name
text · required
patient full name
text · required
patient dob
date · required
mrn
text
laterality
select · required
flacs planned
select
iol type
select · required
target refraction
select
primary indication
select · required
current bcva
text · required
additional risks
textarea
alternatives understood
checkbox · required
followup date
date
questions answered
checkbox · required
governing state
select · required
patient signer name
text · required

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