Signing example
Sign a surgical consent form online
A surgical consent form has to show that the patient was told the specific risks of this operation, made a separate decision about blood products, and signed before the surgeon did. This four page consent for a laparoscopic gallbladder removal has the patient initial both risk pages, mark the blood products box and sign behind an emailed code, with the surgeon's block last.
The document, with its fields
The pages as a signer sees them, with the signature, name, title and date fields placed where each party has to complete them.
Consent for Surgery
1. Patient, surgeon and procedure
| Patient | Helena Brodsky, date of birth 2 August 1974, hospital record number RB-118305 |
|---|---|
| Surgeon | Dr Matteo Garrity, general surgeon, Fellow of the Royal Australasian College of Surgeons |
| Procedure | Laparoscopic cholecystectomy: removal of the gallbladder through four small cuts in the abdomen using a camera, with an intraoperative cholangiogram (an X-ray of the bile ducts during the operation) |
| Possible extension | Conversion to an open operation through a larger cut under the right ribs, if the gallbladder cannot be removed safely through the small cuts |
| Side | Right upper abdomen |
| Planned date | Thursday 22 October 2026, admission at 7:00 am, fasting from midnight |
| Expected stay | Day surgery or one night. Three to five nights if converted to open |
2. Why the operation is recommended
An ultrasound on 4 September 2026 showed multiple gallstones and a thickened gallbladder wall. Ms Brodsky has had three attacks of biliary colic since June, one needing a hospital admission. Gallstones that cause attacks tend to cause more, and can lead to inflammation of the gallbladder, a blocked bile duct or pancreatitis. Removing the gallbladder is the standard treatment. People live normally without a gallbladder; bile flows directly from the liver to the bowel.
3. Other options discussed
| Option | What it means |
|---|---|
| Watch and wait | Change diet and treat attacks as they happen. The stones remain and further attacks are likely |
| Medication to dissolve stones | Rarely effective for stones of this size, takes months, and stones often return when it stops |
| Open operation from the start | Same result, but a larger wound, more pain and a longer recovery |
4. Anaesthetic
The operation is done under a general anaesthetic. The anaesthetist, Dr Yasmin Al-Khoury, will meet Ms Brodsky before the operation, explain the risks of the anaesthetic and obtain a separate consent for it. This form covers the surgery only.
5. Risks of the operation
Every operation carries risk. The risks below were explained by Dr Garrity at the consultation on 29 September 2026. Percentages are approximate and are for this operation in a patient of Ms Brodsky's age and health.
| Common, more than 1 in 100 | What it means |
|---|---|
| Wound pain and bruising | Pain at the small cuts for a week or two, and shoulder tip pain for a day or two from the gas used to inflate the abdomen |
| Wound infection | Redness or discharge from a cut, usually treated with antibiotics |
| Conversion to open operation | About 2 to 5 in 100, more likely if the gallbladder is badly inflamed or there is scarring |
| Bloating and loose bowel motions | Usually settles within weeks as the bowel adjusts |
| Less common, 1 in 100 to 1 in 1,000 | What it means |
|---|---|
| Bile leak | Bile leaking from the liver bed or the clip on the cystic duct. May need a drain or an endoscopic procedure (ERCP) |
| Retained stone | A stone left in the bile duct, which may need removal by ERCP |
| Bleeding | Bleeding needing a transfusion or a return to theatre |
| Blood clots | A clot in the leg (DVT) or lung (pulmonary embolus). Stockings, early walking and blood thinners lower the risk |
| Hernia at a wound | A bulge at the navel cut, months or years later, which may need repair |
Ms Brodsky has read the risks on this page and initials below to show they were explained to her.
6. Rare but serious risks
| Rare, less than 1 in 1,000 | What it means |
|---|---|
| Bile duct injury | About 3 to 5 in 1,000. The main bile duct is cut or narrowed. It may need a major operation to repair and can cause long term problems with the liver |
| Injury to bowel or blood vessel | Damage from an instrument when the abdomen is entered. Usually recognised and repaired at the time, sometimes needing an open operation |
| Death | Very rare in a planned operation for a healthy adult, but it cannot be ruled out entirely |
7. Blood and blood products
A blood transfusion is rarely needed for this operation, but if heavy bleeding happens it may be lifesaving. Blood and blood products in Australia are donated by unpaid volunteers and tested carefully, and the risk of a serious infection from a transfusion is extremely low. A transfusion can cause a reaction such as a fever or a rash, and very rarely a serious allergic reaction. A patient may refuse blood products; the surgeon then explains what that would mean and plans around it.
| Yes | Statement |
|---|---|
| I consent to receiving blood or blood products if my doctors decide they are needed during or after this operation. An X here means yes; an empty box means I do not consent. |
8. Things the patient has told the surgeon
| Item | Detail |
|---|---|
| Medicines | Low dose aspirin, stopped seven days before surgery on Dr Garrity's advice; perindopril, taken as usual with a sip of water |
| Allergies | Penicillin, which causes a rash |
| Previous operations | Caesarean section, 2009 |
Ms Brodsky has read the rare risks and the blood products section on this page and initials below.
9. Who will do the operation
Dr Garrity will perform the operation. A surgical registrar may assist under his direct supervision. If another surgeon would need to perform the main part of the operation, Ms Brodsky will be told before the day.
10. Tissue and images
The gallbladder is sent to pathology for examination, as is routine, and is disposed of respectfully afterwards. Still images from the camera may be kept in the medical record. They will not be used for teaching or publication without separate written consent.
11. Recovery
Most people go home the same day or the next morning, walk the same day, and return to desk work within one to two weeks. Heavy lifting should be avoided for four weeks, or six weeks after an open operation. Ms Brodsky will be given written discharge instructions and an appointment to see Dr Garrity two weeks after surgery.
12. Patient's statement
I confirm that Dr Garrity has explained the operation, the reasons for it, the other options, the risks on pages 2 and 3 and what to expect afterwards. I have been able to ask questions and I am satisfied with the answers. I understand that no guarantee has been given about the result. I consent to the operation described in clause 1, including conversion to an open operation if needed. I understand I can change my mind at any time before the operation.
13. Surgeon's statement
I have explained the procedure, the alternatives and the material risks to the patient in terms she understands, and I believe she has understood the information and is able to give consent.
Who signs what
- Helena Brodsky, patient
- Initials on page 2 and page 3, under the risk tables · An X in the blood products box on page 3 · Signature, stamped date and name on page 4 · Verified by an emailed six digit code
- Dr Matteo Garrity, surgeon
- Signature block on page 4: Name, Title and a stamped Date · Email link
The signing journey
Step 1
Seven fields, mostly the patient's
Two initials spots, one checkbox, a signature, a date and a name for the patient, and one three line block for the surgeon.
Step 2
The patient verifies first
Her link asks for a six digit code from her own inbox before any page opens. The surgeon is not invited yet.
Step 3
Initials on each risk page
Her single drawing fills the initials under the common and less common risks on page 2 and under the rare risks on page 3.
Step 4
A separate answer on blood
The box was left required, so she cannot finish without answering it. She types an X, which the statement beside it defines as yes.
Step 5
The surgeon countersigns
Dr Garrity's invitation goes out when her signature lands. He types his title, General Surgeon, FRACS, and the date is stamped.
Every field, and who fills it
Helena Brodsky initials at the bottom right of page 2 and page 3, types an X in the Yes column of the blood products statement on page 3, then draws her signature on page 4. Her date is stamped and her full name fills from her recipient record. Dr Matteo Garrity's block sits beside hers, headed Surgeon, with Name, Title and Date. The procedure, the 22 October 2026 date, the conversion risk of 2 to 5 in 100 and every other risk are printed in the PDF, not typed.
How to adapt this envelope
An operation where a registrar will perform the main part adds the registrar as a third recipient with a block, after the surgeon. A patient who needs an interpreter is handled in the consultation, and the consent can carry a text field for the interpreter's name. A hospital that wants an empty box to stand as a refusal switches Required off for that checkbox, so a patient who says no can still sign.
What a signature does and does not do
In Australia the Electronic Transactions Act 1999 lets this form be signed electronically where the method identifies the patient and shows her intention. Consent itself comes from the conversation with the surgeon, which national guidance on informed consent expects to cover material risks and alternatives. The form, and the certificate showing who signed, when, from which IP address and after which verification, is the record of that conversation.
What makes this signing flow work
Initials on the pages that matter
Bile duct injury, bleeding, clots and death are spread across pages 2 and 3. A mark at the foot of each shows she had both risk pages in front of her, rather than only the signature page.
Blood products are their own decision
Some patients accept surgery but refuse transfusion. A checkbox with its own statement, where an X means yes and an empty box means no, records that choice separately from the consent to the operation.
A code on the person consenting
The person whose body the consent covers is the one who must be identified. Her emailed one-time code is recorded on the certificate as Email link plus emailed one-time code; the surgeon signs through a plain email link.
Questions people ask
Can a patient sign a surgical consent form from home?
Yes. The link goes to her email, the six digit code to the same inbox, and she can read every page on any device before signing. Many hospitals still confirm consent on the day of surgery, so a signed form at home is the start of the record, not the end.
Why does the surgeon sign after the patient?
His statement on page 4 says he explained the operation and believes she understood it. That only makes sense once she has signed. Sign in order holds his invitation until her signature lands, and the event log shows the sequence.
Does the certificate show where each person signed from?
It records the IP address each signing session came from. In this envelope the patient and the surgeon signed from different addresses, which the certificate shows against each name. It records a network address, not a physical place, so it cannot prove the surgeon was inside the hospital when he signed.
What does an empty blood products box mean?
The printed statement says an empty box means no. In this envelope the box was left required, so the portal would not let her finish with it empty; a patient refusing blood would decline and talk to the surgeon. Switching Required off lets an empty box stand as a no.
Is the anaesthetic covered by this consent?
No. Clause 4 says the anaesthetist meets the patient, explains the anaesthetic risks and obtains a separate consent. That can be its own envelope with the anaesthetist as the countersigning recipient, using the same pattern of initials and a block.
What happens if the patient declines?
The envelope moves to declined and the hospital is emailed with any reason she typed. The surgeon is never invited and no consent exists. She can raise her concerns with the surgeon, and a revised consent can be sent as a new envelope.
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