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Consent Form Requirements <br /> Health and Safety Code <br /> In Out <br /> E] P - client is at least 18-year.,of age- 1193.02(a) <br /> El Parents/Guardian-signature of minor receiving.body piercing-119302(b) <br /> Signature of client agreeing they have read and completed the consent form-119303 (a) <br /> ❑ Description of procedure-119303 (a) I <br /> X-E] Description of what the client should expect following the procedure- 199303(a)2 <br /> El Statement regarding permanent nature of procedure-119303 (a)3 <br /> Post procedure instructions-1193 03 (a)4 <br /> information of proper-care for procedure site <br /> restrictions on physical activities <br /> signs and symptoms of infection <br /> indications when to seek medical care <br /> Medical Questionnaire <br /> H&SC 119303 (b) - <br /> In Out <br /> El Client status regarding pregnancy- 119303 (b) I <br /> ❑ BK1 History of herpes infection at the procedure site-119303 (b)2 <br /> I!(El History of diabetes- 119303 (b)2 <br /> 121"Cl History of allergic reactions to latex-1193 03 (b)2 <br /> V"E] History of allergic reactions to antibiotics-119303 (b)2 <br /> El History of hemophilia or other bleeding disorders-1193 03 (b)2 <br /> El History of cardiac valve disease 119303 (b)2 <br /> A-❑ Current medications-1193 03 (b)3 <br /> 06-0 Requirements for antibiotics prior to surgery or dental procedures-119303 (b)3 <br /> ❑ Other risk factors for blood home pathogens-119303 (b)4 <br /> Form B <br />