CLINIC HQ

14.6. HQ’s Surgical High Risk Waiver Template

The Surgical High-Risk Waiver template is generated from concerns found during a physical exam.

The e-mailed template allows the client to read about the concern and choose to accept or decline the surgery. This HRW is not available for sending before an appointment for known pre-existing conditions.

Download HQ Recommended Templates (follow link and open HQ Templates.) AVAILABLE IN ENGLISH & SPANISH

A good high risk waiver form has four main parts:

  1. Animal/Owner information such as owner’s address and an animal description.
  2. Instructions on Declining the Waiver — the client must be made aware of the option to decline the surgery and the steps for declining.
  3. The High Risk and Explanation of Concern: The HRW Reasons merge field will populate with the selected concern noted in the Exam.
  • From pre-written blurbs in Settings > Medical Notes > High-Risk Waiver Triggered Notes, this field will populate with the specific reason for concern. Learn how to set up these reasons and feel free to use the ASPCA’s pre-written reasons for concern, HERE.
  • Terms of Agreement – this is where your clinic outlines the client’s acknowledgment of increased surgical risks and that there is no guarantee of a successful outcome.

Read more about High-Risk Waivers in Patient Flow.

Tip: If your clinic chooses to use e-consent HRW, it is highly encouraged that you use the HQ Template for a successful e-consent. Clinic HQ’s recommended template is purposely laid out to accommodate the HRW Reason merge field in a fixed table and instructions for declining the waiver.