Benefits of intravenous therapy include
- Injectables are not affected by stomach, or intestinal absorption problems.
- Total amount of infusion is available to the tissues.
- Nutrients are forced into cells by means of a high concentration gradient.
- Higher doses of nutrients can be given than possible by mouth without intestinal irritation.
The Procedure
The IV intravenous procedure involves inserting a needle into your vein and infusing over a determined period of time, prescribed nutrients (vitamins, minerals, amino acids) or chelation agents. Your vitals will be measured prior to and after your infusion.
What Safety Precautions Must You Take?
Monitor the insertion site for signs and symptoms of infection (redness, swelling, discharge). Notify the clinic immediately. If your experience a sustained fever greater than 101, do not delay treatment and go to the ER as this can be a sign of sepsis. If you experience a minor side effect while you are at home, you should contact your medical provider or call 911.My Consent for Nutrient Infusion Therapy is Voluntary
My request for nutrient infusion therapy as described is entirely voluntary and I have not been offered any inducement to consent. I understand that I may refuse treatments at any time.
Statement of Person Giving Informed Consent
I have read this consent form and understand the information contained in it. I understand the risks and benefits and have had the opportunity to have all my questions answered to my satisfaction. I am aware that other unforeseeable complications could occur. I do not expect the provider(s) to anticipate and or explain all risk and possible complications. I rely on the provider(s) to exercise judgment during the course of treatment with regards to my procedure. I understand the risks and benefits of the procedure and have had the opportunity to have all of my questions answered. I understand that I have the right to consent to or refuse any proposed treatment at any time prior to its performance. My signature on this form affirms that I give my consent to IV nutrient therapy.
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RELEASE OF MEDICAL INFORMATION
I hereby authorize to disclose my medical records, to EMS, my spouse, and emergency contact. I also authorize to discuss my care and share my medical information for the purposes of monitoring, quality control or safety concerns.
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