General Consent to Treatment and Financial Agreement

We have updated our General Consent to Treatment and Financial Agreement forms.

The General Consent to Treatment allows Carilion Clinic to provide care. The Financial Agreement allows Carilion Clinic to bill the patient's insurance for treatment provided. Patients are asked to sign these forms one time a year in the ambulatory setting and with each inpatient encounter.

The English-language versions will go into effect on Monday, Dec. 2. The Spanish-language version will go into effect in the near future.

What's Changing

In addition to giving Carilion Clinic permission to treat the patient and bill insurance, the updated forms give Carilion Clinic permission to:

• Make phone calls and send text messages to patients about their medical care, services or account. 
• Send email communications about appointments, products, service reviews, billing and other information related to the patient's care.
• Record trauma resuscitative care if the patient is admitted through the Emergency Department at Carilion Roanoke Memorial Hospital into a trauma bay. If care is recorded, it is only used for quality purposes. Recordings are erased and do not become part of the medical record.
• Contact patients about research participation. We conduct many research studies to learn about new treatments and ways to prevent health problems. Patients may be invited to participate. Patients who do not want to be contacted about research can opt out by calling 540-224-6744 or emailing optoutresearch@carilionclinic.org. 

For More Information

If you have questions, contact Compliance at compliance@carilionclinic.org.