Earlier this year, the Minnesota Alliance for Patient Safety (MAPS) convened a workgroup to develop and pilot a statewide informed consent process. The impetus occurred when the Centers for Medicare and Medicaid Services (CMS) issued new interpretive guidelines requiring a written informed consent form that identifies the procedures to be performed, the practitioner, the risks and benefits, appropriate alternatives and date, time and signature of the person witnessing the patient or the patient’s legal representative signing the consent form.

Health literacy was also a key principle during the development of this new form. The MAPS template informed consent reads at a 4.6 grade reading level. The plan is to have the final layout/designed form by early August, so that the new form can be used across Minnesota health care organizations (hospitals, surgical centers, clinics). We hope to launch this widespread during Health Literacy Month (October).

It is the vision of MAPS that use the informed consent form with little or no variation. MAPS would like this form to be Minnesota’s universal documentation of informed consent. MAPS set out to develop a template form that any clinic could use and every hospital in Minnesota would accept.

(Log-in is required to open these DOCs. Log-in here first, then click 'home' and return to this page.)

• Final Draft of the MAPS Informed Consent Form: [DOC]
• Final Informed Consent Policy: [DOC]
• MAPS Workgroup scope/position: [DOC]

Please send feedback to Tania Daniels, MHA vice president of patient safety, at (651) 603-3517 prior to Friday, July 20.