Chemotherapy Consent Forms for Haematology
Documents
Files(25)
| Name | Size/Type | Description | Date |
|---|---|---|---|
| Belantamab Mafodotin consent | 112KB PDF | Belantamab Mafodotin consent | 01 Mar 2022 |
| Carfilzomib consent | 113KB PDF | Carfilzomib consent | 21 Apr 2020 |
| Carfilzomib, Lenalidomide + Dex consent | 113KB PDF | Carfilzomib Lenalidomide + Dex consent | 02 May 2021 |
| CTD consent | 113KB PDF | CTD consent | 21 Apr 2020 |
| CVD consent | 115KB PDF | CVD consent | 21 Apr 2020 |
| Cyclophosphamide weekly consent | 113KB PDF | Cyclophosphamide weekly consent | 21 Apr 2020 |
| Daratumumab subcut consent | 112KB PDF | Daratumumab subcut consent | 21 Jul 2020 |
| DCVD consent | 111KB PDF | DCVD consent | 21 Feb 2025 |
| Denosumab consent | 111KB PDF | Denosumab consent | 12 Nov 2020 |
| DLD consent | 116KB PDF | DLD consent | 17 Nov 2023 |
| DVD subcut consent | 117KB PDF | DVD subcut consent | 21 Jul 2020 |
| DVTd consent | 117KB PDF | DVTd consent | 13 May 2022 |
| Elranatamab consent | 114KB PDF | Elranatamab consent | 28 Jan 2025 |
| Isatuximab, Pomalidomide + Dex | 114KB PDF | Isatuximab, Pomalidomide + Dex | 19 May 2021 |
| Ixazomib, Lenalidomide & Dex consent | 114KB PDF | Ixazomib, Lenalidomide & Dex consent | 21 Apr 2020 |
| Lenalidomide & Dexamethasone consent | 113KB PDF | Lenalidomide & Dexamethasone consent | 21 Apr 2020 |
| Lenalidomide maintenance post ASCT consent | 111KB PDF | Lenalidomide maintenance consent | 02 May 2021 |
| MPT consent | 112KB PDF | MPT consent | 21 Apr 2020 |
| PAD consent | 114KB PDF | PAD consent | 21 Apr 2020 |
| Panobinostat and bortezomib consent | 116KB PDF | Panobinostat and bortezomib consent | 21 Apr 2020 |
| Pomalidomide consent | 112KB PDF | Pomalidomide consent | 21 Apr 2020 |
| Selinexor + Dexamethasone consent | 110KB PDF | Selinexor + Dexamethasone consent | 17 Jul 2024 |
| SVd consent | 111KB PDF | SVd consent | 17 Jul 2024 |
| VTD consent | 114KB PDF | VTD consent | 21 Apr 2020 |
| Zoledronic acid consent | 115KB PDF | Zoledronic acid consent | 12 Nov 2020 |
Chemotherapy Consent Forms for Haematology
All consent forms on this website are for the use of St Luke’s Cancer Alliance staff in respect of St Luke’s Cancer Alliance patients only.
For those who do not work within St Luke’s Cancer Alliance:
Use of this site and any information on it is at your own risk. We do not accept responsibility for the use of any information that may be set out on the website. You assume full responsibility for the use of the information. You may wish to take your own legal advice before using any of the consent forms.
Please note that the consent forms below are not tumour-specific; one consent form may be used to consent patients for more than one St Luke’s Alliance chemotherapy protocol which uses the same combination of chemotherapy.
These consent forms should act as an aide-memoire to health professionals and patients, by providing a check-list of the kind of information which patients should be offered, and by enabling the patient to have a written record of the main points discussed.
The relevant Macmillan/CRUK leaflet(s) should also be provided to each patient before consent. In no way, however, should written information given to the patient be regarded as a substitute for face-to-face discussions with the patient.