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ULTRASOUND GUIDED FINE NEEDLE ASPIRATE (FNA) AUTHORIZATION FORM

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An ultrasound guided fine-needle aspirate (FNA) is a procedure used to obtain a cell sample from an abnormal area inside of the body.
Minor risks: - Bruising and swelling: It is not uncommon to have some minor bruising at the needle insertion site - Tenderness: The area may feel tender for a few hours or days - Non-diagnostic result: The sample may not contain enough cells for a proper diagnosis, requiring additional testing
Rare complications: While uncommon, serious complications are possible depending on the location of the FNA.
- Infection: There is a very small risk of bacterial infectionInternal Bleeding: Internal bleeding is a rare but life threatening complication - Damage to nearby organs: There is a very small risk of damaging nearby organs - Tumor seeding: This is an extremely rare occurrence in which cancer cells are unintentionally spread - Pneumothorax: A collapsed lung is a very rare but potential life threatening complication for FNA performed in the chest
I have read the above risks and I AUTHORIZE the staff at Gold Coast Center to perform an ultrasound guided FNA. The nature of such service has been described to me to my satisfaction and I realize that no guarantee and no warranty can ethically or professionally be made regarding the results or cure.
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I understand that I assume financial responsibility for all services rendered, and that payment is due upon hospital discharge of the patient.

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