2019

1. Consent in non-emergency situations – General Procedures

1.1. Take consent only of the patient in a non-emergency situation if the patient is adult (also refer to
Clause 6.1), competent (also refer to Clause 6.5), and oriented (in time, place, and person). In
appropriate cases, especially high-risk cases (also refer to Clause 1.18), a confirmation from the
next of kin may be taken or they may be asked to sign as witnesses. (Advisable) In case next of
kin is not available at that point in time, any relative, or even an unrelated friend / neighbour /
attendant may be asked to sign as witness.

1.2. Take ‘proxy’ consent from competent adults responsible for incompetent patients. (also refer to –
‘Chapter 6. Minors / Incompetent / Emergency patients – Proxy Consent)’. In appropriate cases,
signature of witness/es may also be taken (Advisable).

1.3. Do not take consent of spouse, children, or parents (instead of the patient) in case of an adult,
competent and oriented patient. However, they may be asked to sign as witnesses, especially in
high risk cases (Advisable).

1.4. Take consent of both the spouses in case of a legally married patient undergoing Artificial
Reproductive Technique (ART) Procedure.

1.5. Take patient's written consent rather than not taking one (Advisable).

1.6. Take written consent only for those investigations / diagnostics and therapeutic procedures that
require invasive intervention and are not routine. Take written consent (advisable, not mandatory)
for certain non-invasive therapeutic measures such as diathermy, lithotripsy, nuclear-scan,
hormone replacement therapy, drugs having serious side-effects, and such other high-risk cases
(also refer to Clause 1.18).

1.7. No written consent is required:

i. For routine investigations such as drawing of blood.
ii. From OPD patients on routine visits, unless an invasive procedure has to be performed in the OPD.
iii. For non-invasive diagnostic / therapeutic procedures such as ECG, plain CT scan, and so on.

1.8. Do not reduce consent to a mechanical / routine act. Consent is a process and not merely an act
of signing the consent form. It involves providing relevant information about the proposed treatment
/ intervention, discussing with the patient, arriving at a mutual agreement, and then filling and
signing the consent.

1.9. Do not deviate from what has been consented and agreed, except in life-threatening conditions, for
bonafide reasons, and only in the patient’s interest (also refer to ‘Chapter 8: Additional / Alternative
/ Extension during a planned surgery / procedure').

1.10. Take consent only after appropriate disclosures and proper explanation, neither by unduly scaring
nor falsely alluring the patient into acceptance. Follow guidelines on counselling, if any, issued /
framed by national medical associations for that particular therapy / intervention.

1.11. Explain and counsel in the language / dialect understood by the patient. In case services of a
translator / interpreter have been taken, especially in case of international patients, the translator /
interpreter must also sign the consent as witness and record specifically that he / she has explained
in the language understood by the patient and only thereafter the patient has signed the consent.

1.12. Explain and counsel in simple non-medical terms. Brochures / informative booklets about the
interventions / therapies could be provided to the patient (Advisable) (also refer to clause 1.21).

1.13. Explain and counsel the various aspects of the proposed treatment / intervention to the patient by
handwritten notes / diagrams / figures / images / models / posters of organs / systems / diseases
and only if the same are easily available. Append these with the consent form. Thereafter follow
the protocol, as far as applicable, prescribed in Clause 3.13 (Advisable).
1.14. Disclose to the patient and duly record in the consent:
i. Medically approved name of the treatment / surgery / procedure.
ii. Nature and purpose (intended benefits) of the treatment / surgery / procedure and the trouble /
disease / complication for which the same is advised.
iii. Likely prognosis in accordance with the accepted medical practice.
iv. Risks involved - the most commonly occurring risks and not the rare ones (also refer to – ‘Chapter
4. Risk information)’.
v. Commonly occurring life-threatening and non-life-threatening complications / consequences - Even
complications / consequences that are rare but likely to affect vision, hearing, motor and brain
functions, or may result in amputation, disability, paralysis, or serious bleeding (Advisable).
vi. Available alternatives – The relative advantages and disadvantages of each of the available
alternatives and the preferred one with reason/s.
vii. Adverse consequences of refusal by the patient.
viii. The fact that the surgeon may come across unexpected situations during the course of surgery and
it may require additional / alternative / extension other than what has been consented, and that the
patient consents for the same.
ix. In certain aesthetic / non-therapeutic interventions, disclose / record specifically that the outcome
may not be commensurate with the patient’s expectation due to anatomical / procedural limitations.
x. Name of the principal surgeon and principal anaesthetist.

1.15. Give the patient reasonably enough time, depending on the situation, to take decision for giving
consent after counselling except in emergency situations such as caesarean, evacuating clot
setting on brain, need for mechanical ventilation, and so on. If the clinical condition of the patient
changes during this period of patients’ contemplation, initiate the process for taking fresh consent.

1.16. Video-record the pre-consent counselling session, especially in high-risk cases (also refer to
Clause 1.18), only if the requisite facilities are easily available. Ensure that the CCTV signage is
present in the counselling room and the patient is specifically informed of this fact. (Advisable)
Video-recording of consent is legally compulsory only in transplant surgeries and clinical trials.

1.17. Multi-stage treatment - Take single and comprehensive consent explaining the different stages one
after the other even if the different stages are contemplated to be performed on different dates.
Enumerate each stage specifically and separately in the consent. After taking such consent, if the
patient's condition changes significantly and/or any deviation is contemplated in the subsequent
stages from the consented course, a fresh consent must be taken.

1.18. High-risk Consent: Inform the patient specifically, duly record the same in the medical records, and
take an elaborate 'high-risk' consent if:
i. Unusual requests are made by patient / attendants, abnormal / suspicious circumstances, and such
other conditions.
ii. The treatment / recovery is expected to take a very long time.
iii. The rate of failure is high.
iv. The technique / procedure / drug / protocol is relatively new / critical / complicated.
v. Relapse is common.
vi. Presence of any co-morbid condition that may interfere with the surgery / procedure / treatment.
vii. The patient is in a critical state or is even otherwise at high risk.
viii. Removal of any organ / limb is a possibility.
ix. You are proceeding with a surgery / procedure / treatment in spite of abnormal parameters.
x. The patient has potential for creating trouble.
xi. The commonly occurring complications of the proposed technique / intervention / drug / protocol
are serious / life-threatening.

1.19. Independent witness:

i. Take patient’s consent in the presence of minimum one independent witness in case of high-risk
consent (also refer to – Clause 1.18).
ii. Ideally the witness should not be connected / employed / related to the doctor, hospital, or patient.
A patients relative knowing English or the language of the consent form could be a good choice as
an independent witness.
iii. The witness must write in his / her handwriting on the consent form that the patient has informed
the witness that the patient was explained the content of the consent form in the language / dialect
known and spoken by the patient; the patient has consented to the same; and thereafter the patient
has put his / her signature / thumb impression on the consent form in front of the witness. The
witness must then sign the consent form, write his / her name, relation with the patient, and contact
 coordinates. A copy of identity proof of such a witness must be taken for the purpose of traceability
and preserved with the consent form.
iv. Translator / interpreter whose services have been used could be an independent witness for that
particular patient (also refer to Clause 1.11).
v. The witness should be easily traceable in future and should not have any reservations in coming
to the court and / or giving statements / affidavits.

1.20. Record specifically in the consent form if a consultant / surgeon has agreed to manage the patient
only for a specific period or only to perform a surgery / procedure and that thereafter the patient will
be managed by other / another designated / assistant doctor. This clause will not apply to public
hospitals / 'group practice'. In case of 'group practice', patient's consent must be taken for the group
and name of all the members of the group must be clearly recorded in the consent form.

1.21. Prepare and provide the patient with a brochure / informative booklet, preferably in the local
language/s, describing the therapy, risks, prognosis, and advantages of the treatment /
interventions especially in case of rare / new / complicated / risky - treatments / surgeries /
procedures. The aforesaid should be provided beforehand and the patient must be given a
reasonable time to contemplate to take a decision. Append a copy of such brochure / booklet
bearing patient / attendants acknowledgment of receipt with the consent form.

1.22. Check specifically whether the patient's signature on the consent form is in English or not. If the
signature is not in English, follow the protocol, as far as applicable, prescribed in Clause 1.23.

1.23. Taking consent of a patient not conversant with English / illiterate / semiliterate:
i. Exercise greater caution.
ii. Give the requisite information in the language / dialect known to the patient.
iii. If the doctor cannot speak the dialect, the patient must be asked to bring someone who can
understand, translate, and explain to the patient. If the patient expresses inability to bring anyone,
a staff member, or someone known to the doctor can be involved; but only as a last resort. Record
this fact in the consent specifically (Advisable).
iv. Take thumb impression (left hand for males and right hand for females) or signature of the patient.
v. Take signature of an independent witness (also refer to Clause 1.19) (Advisable).
vi. Specifically record the fact that consent was taken after counselling in the patient’s language.
vii. Ensure that the patient does not write anything on the consent that cannot be understood by the
doctor / hospital staff.

1.24. Take thumb impression (left hand for males and right hand for females) on the consent of a literate
patient who is unable to sign due to any reason. Record specifically the reason for taking thumb
impression and also take suitable endorsement from the patient's relatives / friends / attendants on
the consent, if possible. Follow the protocol, as far as applicable, prescribed in Clause 1.23.

1.25. Therapeutic Privilege: A doctor withholding information from the patient for therapeutic purpose:
i. Exercise this option very rarely, in the patient’s interest and only if disclosure would otherwise
interfere with treatment, adversely affect the condition / recovery of the patient, or in case of certain
diseases that are considered taboo.
ii. Explain the reasons for withholding any information from the patient to the patient’s attendants /
relatives and take their written endorsement of having received this information.
iii. Take opinion of other doctors involved with the patient and if they agree with your decision of
withholding information from the patient take their written endorsement (Advisable).
iv. Any such request made by patient’s attendants / relatives, especially spouses, children or parents
must be given due importance, but the final decision must always be taken by the doctor. Take
their request in writing, take their proof of identity, and duly preserve both with the consent.

1.26. Procedures / treatment with pure cosmetic values (generally performed by dermatologists,
cosmetologists, dentists, and so on) where usually the acceptance of post-procedure / treatment
results is highly subjective, perceptive, and sensitive - Take additional consent of the patients’
spouse / parents / relatives / friends but only after taking specific consent of the patient for the same
(Advisable).

2. Consent Form
2.1. Printed consent forms in English can also have its printed translated version in the local language
appended as a separate leaflet or printed on the reverse side (Advisable).
2.2. Printed consent forms must have enough blank spaces for filling complete and additional
information.

2.3. Consent forms can have suitable columns / spaces for the patient to indicate whether the patient
has executed any 'Advance Medical Directive (AMD)' in accordance with the law laid down by the
Supreme Court or to indicate the names of relatives / attendants whose directions should be
followed in case the patient is not in a position to give further directions. Patients can fill this column
/ space with full name, address, and telephone number of such relatives / friends and also indicate
the order of preference amongst them (Advisable).

3. Filling the Consent Form

3.1. Consent form printed in the local language or the language understood by the patient must be filled
in the same language (Advisable).

3.2. Consent form can be filled / written by a doctor / nurse. (This clause is for filling of the consent form
and should not be confused with signing of the same).

3.3. Fill the consent form in one sitting even though counselling the patient may take more than one
sitting (Advisable).

3.4. Avoid changing the pen or the person who is filling the consent form midway. Maintain uniformity
in filling the consent form (Advisable).

3.5. Make entries in the designated spaces only. Mention specifically that appendices have been
annexed if the designated space is inadequate.

3.6. Fill the consent form completely. Do not leave any space blank in a printed consent form. Write
'Not Applicable' or 'NA' in spaces where nothing has to be written (Advisable).

3.7. Try to avoid alteration, addition, overwriting, or erasure while filling the consent form. In case any
change has to be made, encircle the wrong portion, cancel with a single stroke and write the correct
entry besides it with counter signatures, rather than erasing or putting white ink. Filling a fresh
consent form would be a better option (Advisable).

3.8. Take the patient’s signature / initials on every page of the consent form (Advisable).

3.9. Doctor-in-charge of the patient / principal surgeon / principal anaesthetist should also sign the
consent form.

3.10. Record specifically the name of the doctor / nurse who has obtained patient’s signature on the
consent form (Advisable).

3.11. Fill the consent form in legible handwriting. Avoid using abbreviations.

3.12. Writing a new sentence on a printed consent form below the space designated for the patient's
signature - Take patient's signature with date and time below this newly added sentence.

3.13. Additional page / document appended with a consent form:

i. Append all these papers after the printed consent form.
ii. Number them serially. The printed consent form must also be numbered.
iii. Take patient’s signature on each page.

4. Risk Information
4.1. Explain and record the most commonly occurring risks in the consent.

4.2. All material risks having probability of 10% or more must be specifically spelt out to the
patient and duly enlisted in the consent. The exact percentage of the risk as stated / accepted by
medical science need not be specifically mentioned in the consent.

4.3. Answer questions raised by the patient about a specific risk and record the same in the consent.
4.4. During pre-surgery / procedure / treatment counselling, disclose to the patient and duly record in
the consent:
i. If the failure rate is higher, or relapse, or recurrence is a known possibility.
ii. Risk involving loss / diminution of life, vision, hearing, mental function, function of limbs and organs,
or may result in amputation, paralysis, or serious bleeding even though the risk maybe rare
(Advisable).

4.5. Avoid disclosing risks that are remote, or will frighten, or confuse the patient (Advisable).

5. Emergencies
5.1. Do not wait for consent in emergencies, if waiting could be detrimental to the patient.

5.2. Emergency patient incompetent to give consent; unaccompanied / unconscious patient; or patient
brought by unrelated person/s:
i. Proceed with lifesaving treatment / surgery by taking oral consent of the patient and in appropriate
cases even without consent.
ii. Take proxy consent if the relatives / attendants are present at that point in time, or even from
another doctor / Medical Superintendent / Head of the hospital, only if possible, and without much
effort.
iii. Duly inform the hospital authorities.
iv. Record specifically in the patient's medical records and / or the consent form the life-threatening
emergency as well as the reason/s for not obtaining consent, or for obtaining proxy consent. This
exercise can even be done once the emergency is over.

6. Minor / Incompetent / Emergency patient – Proxy Consent

6.1. Consent and Age:
i. Child patient below 12 years - Take consent of the parents / guardian only.
ii. Child patient between 12 to 18 years - Take consent of the patient as well as the parents / guardian.
iii. Adult patient above 18 years - Take consent of the patient only.

6.2. Proxy consent 'giver' for minor / incompetent / emergency patient:

i. Spouse / blood relatives / any other relative.
ii. Biological parents / guardian (both legal as well as de-facto).
iii. Even the teacher / warden who brings the child to the doctor / hospital but only in an emergency.
iv. Consent of any one of the parents is valid and binding even if there may be difference between
both the parents.
v. Person not connected or related with the patient but who may have brought such a patient (e.g. in
accident cases).
vi. Medical Superintendent / Head of the hospital or such other responsible person in institutions /
hospitals.
vii. Person/s expressly indicated by the patient to give consent in accordance with his / her Advance
Medical Directive (AMD) as prescribed by the Supreme Court.

6.3. Taking proxy consent:

i. Verify and record specifically the name, address, telephone number, and relationship with the
patient of the person from whom proxy consent has been obtained. It is advisable and not
mandatory to take a self-attested photocopy of the proof of identity (having photo, age, and
signature) of the person giving proxy consent for the purpose of traceability. Match the signatures
on the consent with that on the proof of identity.
ii. Record specifically the reason/s for obtaining proxy consent in the consent.
iii. Further directions / consent during the treatment may be sought from such a person.

6.4. Patient's orientation seems doubtful - Follow the protocol for incompetent patients rather than
treating the patient as a competent one (Advisable).

6.5. Incompetent Patient - Means and includes minors; a person with mental illness who lacks the
mental capacity or suffers from cognitive impairment or decline; unconscious or anesthetized with
alteration of sensorium; under the influence of drugs, sedatives, alcohol or substances that cloud
consciousness or judgment; in such pain and agony that the patient is not in a position to give
consent or complete other formalities; and so on. A disoriented patient is an incompetent patient.
6.6. A patient in labour with severe pain is competent to give consent.

7. Surgery / Procedure / Intervention

7.1. Do not take 'blanket' consent, general in nature, at the time of admitting a patient for surgery /
procedure.

7.2. Try to take consent closer to the day of the surgery / procedure (Advisable).

7.3. Disclose to the patient during pre-surgery counselling and record specifically in the consent if:
i. Any decision may have to be taken on the operation table after opening the patient - Even if it is
the choice of not proceeding further after opening such as in case of advanced cancer or
tuberculosis.
ii. Damage / removal of important organs is a possibility.
iii. Any other alternative/s may have to be adopted after opening the patient. Record specifically all
such alternatives, if anticipated.
iv. The surgery / procedure may require multiple stages / sessions / sittings.
v. Corrective surgery / procedure may be required to deal with known post-surgery complication/s.
vi. Re-operation / second intervention may be needed.
vii. Relapse / recurrence / failure is a known possibility for that particular surgery / procedure / disease.

7.4. Record the date fixed for performing a scheduled, non-emergency / elective surgery / procedure in
the consent.

7.5. No fresh consent is required if the surgery / procedure is rescheduled but without any change to
whatever was originally consented by the patient. However, if the surgery is postponed by more
than 48 hours, contemplate of taking a fresh consent or just add a line below the already signed
consent validating it on the current date by signing afresh (Advisable).

7.6. Take composite consent for both the surgery / procedure and re-exploration, if foreseeable and
anticipated.

7.7. Take separate consent for each procedure / surgery, if two or more surgeries / procedures are to
be performed together either by the same surgeon or by different ones.

7.8. Take separate and specific consent for each and every foreseeable and anticipated alternative
surgery / procedure. Consent for a difficult / complicated surgery / procedure does not automatically
operate as consent for a comparatively easier / simpler alternative. Additional / alternative /
extension that may have to be performed during the course of a surgery / procedure is not intended
to be covered by this clause (also refer to Clause 8.3).

7.9. Take 'high-risk consent' (also refer to Clause 1.18) in appropriate cases. Inform the patient /
attendants accordingly and record the said fact specifically in the medical records also.

7.10. Anaesthesia:
i. Take separate specific consent for anaesthesia.
ii. Duly record the type of anaesthesia - general / local / epidural / spinal / nerve block or any other in
consent.
iii. Take advance consent for each option, if multiple anaesthesia options are contemplated in
alternative.

7.11. Record specifically name of the principal surgeon and the principal anaesthetist in the consent.

7.12. Take a fresh consent if the doctor scheduled to perform a surgery / procedure for whom the patient
had specifically consented is changed.

7.13. Non-availability of the surgeon for post-surgery care especially when the surgeon has agreed only
to perform the surgery / procedure and thereafter the day-to-day management would be the
responsibility of others or of another designated doctor or a team of doctors:
i. Inform the patient in advance of the aforesaid and record it specifically in the consent. Emergencies
are exceptions as far as informing the patient is concerned.
ii. Provide proper substitute even in an emergency not anticipated by the surgeon.
 iii. This clause will not apply to public hospitals / 'group practice'.

7.14. Confirm before starting every surgery / procedure whether the OT nurse has personally checked
the consent form/s in the patient's medical records, it is signed by the patient and complete in all
respect.

7.15. In case of an accidental injury / mishap / complication during a surgery / procedure, follow the
protocol, as far as applicable, prescribed in Chapter 8. 'Additional / Alternative / Extension during a
planned surgery / procedure'.

7.16. Do not take separate consent for sending any part / tissue / fluid / organ removed from the patient's
body for usual cytological or histopathological examination. But sending it for research purpose
requires separate specific consent as per ICMR guidelines.

8. Additional / Alternative / Extension During a Planned Surgery / Procedure

(same anaesthesia period)
8.1. Discuss, explain, and take specific consent beforehand for any additional / alternative / extension
that may have to be performed during a planned surgery / procedure when the patient would be
unable to take an informed decision.

8.2. Record specifically the name/s of each of the anticipated and foreseeable additional / alternative /
extension in the consent.

8.3. Additional / alternative / extension during the course of a surgery / procedure without the patient’s
specific consent.
i. Do not proceed without specific consent only because it would be beneficial to the patient or would
save considerable time and expense of the patient or relieve the patient from pain and suffering in
future.
ii. Proceed only if it is ‘necessary in order to save the life, limb or organ, or preserve the health of the
patient and it would be unreasonable to delay’.
iii. Take written consent, if possible, from the patient’s attendants (Advisable).
iv. Record specifically and elaborately the reason/s for the additional / alternative / extension in the
intra-surgery notes and in the written consent taken from the patient’s attendants (if one has been
taken).

9. Family Planning Procedures

9.1. Counsel the patient (beneficiary) before taking consent for any family planning procedure. It is
advisable to counsel the spouse also but with the patient's consent.

9.2. Make enquiries whether the couple has one living child above the age of 1 year in accordance with
the revised national guidelines and record this fact specifically in consent. However, the decision
to undergo the procedure is still the patient's exclusive choice irrespective of past obstetric history.

9.3. Inform the patient and record specifically in the medical records:
i. The probability of failure of the procedure.
ii. The post-procedure precautions of abstinence for a specific period of six weeks, during which use
of contraceptive like use of condoms, etc. is recommended.
iii. Missing of period by female patient after post-procedure needs to be taken as sign of pregnancy
and that government hospitals offer to perform Medical Termination of Pregnancy (MTP) free of
charge.
iv. Record the aforementioned specifically in the consent.

10. Sterility Anticipated in an Intervention

10.1. Take consent of both the husband and wife for interventions that may result in sterility.

10.2. Interventions that may result in sterility in an unmarried patient / live-in couples:
i. Take a simple declaration about the patients’ marital status along with the consent.
ii. Carefully preserve this declaration with the consent.
iii. No consent of the other partner is required in such cases and only the patients’ consent will suffice.
11. Medical Termination of Pregnancy
11.1. Take only the patient's (woman) consent for MTP in Form C appended to MTP rules - Even
administering MTP pill requires consent. In case of minors, take guardian's signature on Form C.

12. Blood / Blood Products Transfusion

12.1. Take separate and specific consent for blood / blood product/s transfusion in all cases where
transfusion is foreseeable and anticipated.

12.2. In emergencies and in cases where blood / blood product/s transfusion could not have been
foreseeable and anticipated, blood / blood product/s transfusion even without consent is
permissible.

12.3. Take consent for blood / blood product/s transfusion for all surgeries / procedures along with
consent for surgery / procedure (Advisable).

12.4. Counsel the patient that even though transfused blood / blood product/s is tested for HIV, HCV,
Hep B and other microbial contamination / transmission according to the current guidelines, yet
there remains a minimal but potential probability of these diseases getting transmitted to the
recipient as they cannot be always detected by tests done in blood banks (Advisable).

12.5. Consent for transfusion of blood / blood product/s once given by the patient remains valid for
multiple transfusions in the same sitting or multiple sittings spread over a few days.

12.6. Patients who are transfusion dependant (haemophilia, thalassemia, etc.) or require to undergo
procedure for a long time (dialysis) - Consent for transfusion of blood / blood product/s once given
by the patient to a doctor / hospital remains valid till the time it is specifically withdrawn by the
patient.

13. Delay / Refusal to Consent

13.1. Record specifically in both the consent and the medical records, if there is any delay / failure /
hesitation / unwillingness / refusal / dissent on the part of the patient to give consent form.

13.2. Follow the protocol, as far as applicable, prescribed in Chapter 14. Patient giving part consent and
part refusal.

13.3. Record specifically the date and time when the patient's consent was sought and when the patient
gave or refused to give consent in both the medical records and consent.

13.4. The doctor can withdraw from the patient / transfer the patient, in a non-emergency situation, if
consent is refused or unusually delayed.

14. Patient Giving Part Consent or Part Refusal

14.1. Contemplate whether the consented part can be disconnected from what has been refused.

14.2. Weigh the consequences of part consent - The doctor may even choose to withdraw from the
patient in appropriate cases and non-emergency situation.

14.3. In case one proceeds with part consent - clearly record that the patient has given only part consent
in the consent form; get the consent form attested by minimum one independent witness (also refer
to Clause 1.19); and also record this fact in the patient’s medical records.

15. Patients Refusal of the First / Best Option and Choice of Another Medically
Acceptable Option
15.1. Take elaborate consent recording both the best option and the option chosen by the patient.

15.2. Explain to the patient and specifically record the relative advantages and disadvantages of both
the options.
16. Clinical Examination of Living Person for Medicolegal Purpose
16.1. No consent is required for clinical examination of a living person brought by the police, any other
law-enforcing agency or even a walk-in patient like victim of road accident, suicide survivor,
homicide survivor, and so on. But if such a person is brought by the police, request for examination
must be entertained only if made by "a police officer not below the rank of sub-inspector" as laid
down in Section 53 of the Code of Criminal Procedure, 1973.

16.2. Take specific written consent of the survivor of sexual abuse for clinical examination (per vaginal /
per rectum) even if brought by the police. If the victim is incompetent, follow the protocol, as far as
applicable, prescribed in ‘Chapter 6. Minors / Incompetent / Emergency patients – Proxy Consent'.

16.3. Record elementary details like the name, designation, police station of the police officer who has
brought the patient; name and age of the patient; date and time of examination; the purpose of
examination; the procedure; and so on.

16.4. Consent for treatment / surgery / procedure is required even in these cases.

16.5. Consent of prisoners (under-trials and convicts) / persons under arrest or police custody is required
like any other ordinary person for any treatment / surgery / procedure. In case of an 'incompetent'
(also refer to – Chapter 6) prisoner, the Medical Superintendent of the hospital or the jail officials
can give proxy consent.

17. Consent for Post mortem

17.1. post mortem in case of suspicious / unnatural death where the cause of death is not known to the
doctor - No consent of the patient’s relatives / friends / attendants is required for referring the dead
body to police for post-mortem.

17.2. Pathological autopsies / post mortem in case of natural death (usually for academic and research
purpose) - Consent of nearest relatives must be taken. Such consent can be withdrawn at any
stage but before the procedure has started.

18. Consent for HIV Test

18.1. Take written consent of the patient after proper counselling.