• INFORMED CONSENT AND WAIVER FOR EMG/NERVE CONDUCTION STUDIES DURING COVID-19 PANDEMIC

  • There is nothing more important to us than your health and safety during this unprecedented time. As EMG/NCS studies can be an essential component of health care during the coronavirus (COVID-19) epidemic, we have remained open to serve our patients who are in need of the studies.

    We are taking preventative measures and have implemented protocols, guided by the CDC, to help protect our patients and staff. Among other things, all patients are screened upon arrival for their appointment to make sure they are not exhibiting any symptoms. If a patient presents with COVID-19 symptoms, they will be advised to return home and contact their primary care physician. It is important that you provide honest answers to the screening questions and that you accurately report your health condition so that we can help protect you and others from the further spread of the virus to the extent possible.

    Although we are taking precautionary measures to help minimize the risk of COVID-19 exposure, it is simply not possible to completely mitigate those risks. There is consequently a risk that you could be exposed to COVID-19 during your visit to our office and that you could contract COVID-19 either during the course of your visit or while traveling to or from your appointment. The risks of COVID-19 include, but are not limited to, respiratory problems and other complications which could result in death. It is consequently important that you carefully consider the risks and benefits of proceeding with treatment given the risks associated with COVID-19.

    The CDC recommends that patients who are over the age of 65 or who have health conditions that make them particularly susceptible to complications if contracting COVID-19 to remain at home and to reschedule their medial appointments for a later date. If you do not feel comfortable keeping your appointment, we will gladly reschedule your appointment for a later date.

    Patients who desire to move forward with their treatment are being asked to confirm in writing that they are aware of the risks to them of COVID-19 and to acknowledge that they nevertheless desire to proceed with their appointment.

    The Nerve Conduction Study (NCS) checks how quickly impulses travel between nerves. You will have small metal disks, called recording electrodes, attached to your skin with conduction gel on one part of your limb or body. Mild electrical currents are delivered from the machine through a pair of electrodes attached to another part of that limb or your body. This is delivered as a brief electric shock. The amount of the electrical current is always kept at a safe level. You will feel a tingling sensation and your muscles will twitch as the current flows from that point to the recording electrodes. It will be recorded on the EMG machine. The test will not harm you but it may be painful.

    The EMG is a diagnostic procedure to assess the health of muscles and the nerve cells that control them (motor neurons). EMG results can reveal nerve dysfunction, muscle dysfunction, or problems with nerve-to-muscle signal transmission. The physician uses very thin, fine needles about one and a quarter inches long that are attached to the EMG machine. The skin is cleansed with an alcohol wipe and then the needle is inserted into the relaxed muscle to be evaluated. You may feel a pinch or a sting as the needle is inserted through the skin. When the needle is inside the muscle you may feel a pressure or discomfort. This is necessary to assess the ability of muscles to respond to nervous stimulation. No electric currents are used. The EMG will record the muscle activity and can be heard as static on the EMG machine. You will be asked to tighten your muscles to also evaluate them at work. After the test, there are no activity restrictions. At times you may have some minor aches or discomfort. If so, take it easy that day. Minor risks include bruising, slight bleeding, and brief period of muscle pain after the test. Although infection is a possibility, it is very uncommon. If you notice worsening bruising; increase in discomfort; or signs of infection such as redness, warmth, swelling, pain, drainage or fever > 101 degrees F; please call your specialist or physician immediately.

    By my signature below, I acknowledge that the risks and benefits of EMG/NCS studies have been explained to me and that all of my questions have been answered to my satisfaction. I further acknowledge and understand the risks associated with the EMG/NCS studies, and I also understand the risks associated with COVID-19.

    I believe that it is in my best interest to proceed with the EMG/NCS studies in order to more fully evaluate my medical condition and to potentially avoid complications or adverse physical affects delaying evaluation and treatment may cause. I acknowledge that there is no way for Precision Occupational Medical Group, Inc. to fully mitigate or eliminate the risks of COVID-19 exposure, and I understand that, by proceeding with the EMG/NCS testing, I am at risk for contracting COVID-19 and that a COVID-19 infection could cause serious health issues, including death. I nevertheless wish to proceed with the studies, and I hereby waive and release Precision Occupational Medical Group, Inc. and its shareholders, officers, directors, agents and employees to the fullest extent permitted by law from any and all liability arising out of or relating to my potential exposure to COVID-19 as a result of undergoing EMG/NCS studies.

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