Informed consent for spinal cord stimulator (SCS) trial implantation, including lead placement, programming, trial period expectations, risks, benefits, and explant procedure.
The Spinal Cord Stimulator Trial 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, pain management, spinal cord stimulator, scs, neuromodulation, interventional pain. 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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# Spinal Cord Stimulator Trial Informed Consent > **Important — not medical advice.** For use by a licensed provider; tailor to the patient, your protocols, and state law. **Provider / Practice:** ___________ **Patient Name:** ___________ **Date of Birth:** ___________ **Medical Record Number:** ___________ --- ## 1. Procedure Proposed **Procedure:** Spinal Cord Stimulator (SCS) Trial — Percutaneous Lead Placement **Device Manufacturer / System:** ___________ **Target Anatomy / Lead Level:** ___________ **Performing Clinician:** ___________ **Facility / Location:** ___________ **Planned Trial Duration:** ___________ --- ## 2. Indication **Diagnosis / Reason for Procedure:** ___________ Spinal cord stimulation is considered when chronic pain has not responded adequately to conservative measures, medications, or other interventional treatments. The trial is a required evaluation period before permanent implantation to determine whether SCS provides meaningful benefit for the individual patient. --- ## 3. Description of the Procedure