Dialysis Patient Consent to Release Health Status Information to Fellow Patients

Form Template

When undergoing treatment for kidney disease, a patient may spend a significant amount of time at a dialysis facility and come to know fellow patients as a family through the shared experience.

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While HIPPA privacy laws protect patients' rights, some patients may want to use The Dialysis Patient Consent to Release Health Status Information to Fellow Patients app. This app is a unique health status consent form that provides a patient to give the medical care team permission to share information with fellow patients. This form allows the patient to decide who the dialysis team can inform regarding health status changes.

Using the form, the patient will not only be able to identify who can receive health updates but also can select which specific health factors can be shared like hospitalization or transplant. For example, if a patient is leaving the dialysis center for some time to undergo a transplant, the patient may want others to know why they are missing. By using this form, patients can have more autonomy over health status information, promote community within the dialysis facility, which in turn may lead to a better quality of life.

Use this informed consent tool as a health care providers to ensure that a patient can release pertinent health information to others in the dialysis community. As clinicians at a health care facility, use this app before disclosing information on surgical procedures or dialysis treatment as part of long-term care of a patient. As a physician or nurse, inform the appropriate community members at a hospital dialysis unit when a patient and health professionals make clinical health care decisions based on treatment options and what the outcomes are.

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