1. CONSENT FOR TREATMENT. I voluntarily consent to inpatient and/or outpatient care and treatment performed by my physician and all other health care providers at UCH. I also consent to routine hospital services, diagnostic procedures, medical treatment, and other services and hospital care as deemed necessary by the health care providers treating me. I understand that the practice of medicine and surgery is not an exact science and that diagnosis and treatment may cause injury or even death. I understand that I have a right to consent or to refuse to consent to any proposed surgery, procedure or treatment, and to discuss it with my health care provider. If this Admission Agreement is signed as part of an Emergency Department of other outpatient visit, it will continue for any related inpatient admission. I understand that if I am participating in a research protocol and have signed the Colorado Multiple Institutional Review Board (COMIRB) consent form, I am exempt from paragraphs 2 and 3 of this Admission Agreement with respect to the services specifically described in that research protocol. I understand that all provisions of this Admission Agreement shall apply to those tests and services not included within the research protocol.

1. SAGLASNOST O MEDICINSKOM TRETMANU. Dobrovoljno pristajem na bolničku i/ili ambulantnu njegu i tretman od strane mog ljekara ili nekog drugog zdravstvenog radnika iz UCH. Takođe pristajem na rutinske bolničke pretrage, dijagnostičke procedure, medicinske tretmane i druge usluge i svu bolničku njegu zahtjevanu od strane zdravstvenih radnika koji se o meni staraju. Svjestan sam da medicinska praksa i hirurgija nisu egzaktne nauke i da dijagnostika i liječenje mogu da izazovu povredu ili čak i smrt. Svjestan sam da imam pravo da pristanem ili da odbijem bilo koju ponuđenu hiruršku intervenciju, proceduru ili liječenje, i da se o tome dogovorim sa svojim ljekarom. Ukoliko je ovaj Sporazum potpisan prilikom prijema u Odjeljenje hitne pomoći ili u ambulantnu ustanovu, on nastavlja da važi i pri prijemu na bolničko liječenje. Shvatam da sam, ukoliko učestvujem u protokolu o istraživanju i potpisnik COMIRB formulara o saglasnosti (Colorado Multiple Institutional Review Board - Kolorado multiinstitucionalna komisija za odobrenja), oslobodjen obaveza navedenih u paragrafima 2 i 3 ovog Sporazuma u smislu usluga posebno opisanih u protokolu o istraživanju. Shvatam da se sve stavke ovog Sporazuma odnose na one testove i usluge koje ne spadaju u protokol o istraživanju.