When an adult represented by the Curateur public cannot consent to proposed care, the physician uses this request to obtain substitute consent from the Curateur public as legal representative. Companion requests cover a level of care or goals of care and control measures. The Curateur public's Direction médicale et du consentement aux soins reviews the request and sends its consent to the person named in the form's return section.
The professional proposing the care assesses the person's ability to consent and completes the request, and the physician who proposes the care signs the clinical description. There is no patient section, but the form records what the person and a relative were told and the wishes they expressed.
Download the current version from the source each time; forms change without notice.
Request for consent to care (also: to a level of care/goals of care, to control measures) – person represented by the Curateur public
Demande de consentement à un soin (aussi : à un niveau de soin ou objectif de soins; à des mesures de contrôle)
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The professional proposing the care assesses the person's ability to consent to that specific care each time care is proposed, and records the result on page 2. Being represented by the Curateur public does not by itself make a person unable to consent. If the person is able, they consent themselves.
Yes. The Curateur public publishes it in French as Demande de consentement à un soin and in English, on its forms page for the health and social services network. The related requests for a level of care or goals of care and for control measures are also posted in both languages.
Page 3 asks for the advantages and disadvantages of the care and possible alternatives, the diagnosis and medical history, and a general profile: ability to express needs, judgment and cognition, mobility, continence, autonomy in eating, bathing and dressing, activities and collaboration with care. The physician then signs and dates it.