Utah Medical Candor Act Resources

Utah Medical Candor Act—Consent and Other Forms

General templates of forms used during the Candor process for the health care community to download and use. PLEASE NOTE: All forms use the language required under the Utah Medical Candor Act and any edits should be made and/or reviewed by the proper legal counsel.

• Health Care Provider Notice for Medical Candor Process

  Initial form to be completed by health care provider and/or health care facility and sent to the patient/patient representative to notify him or her that the provider/facility would like to utilize the medical candor process.

  Patient Consent to Participate in Medical Candor Process

  Form that needs to be signed by patient/patient representative and returned to the provider to initiate the medical candor process; this also outlines the required steps that must be followed in order to comply with the law.

  Participation Agreement in Medical Candor Process

  Form to be completed by others (e.g., family members, patient’s attorney, etc.) who would like to participate in the medical candor process alongside the patient.

  Patient Acknowledgment of Health Care Provider Advisement and Notice Related to Offer of Compensation

  Notifies the patient of requirements outlined in the Utah Medical Candor Act when an offer of compensation is made and the patient is not represented by legal counsel; this also outlines additional requirements that may be made by the health care provider or health care facility as a condition of an offer of compensation.

  Health Care Provider Notice and Invitation to Participate in Medical Candor Process

  Form to be completed by the initiating provider and sent to other providers involved with the patient’s adverse event to invite them to engage in the medical candor process.

Utah Medical Candor Act en Español (Spanish versions)

• Acuerdo De Participación En El Proceso Del Candor Médico En Las Conversaciones (Participation Agreement in Medical Candor Process)

  Aviso Para Proveedores De Atención Médica E Invitación A Participar En El Proceso Del Candor Médico En Las Conversaciones (Health Care Provider Notice and Invitation to Participate in Medical Candor Process)

  Aviso Del Proveedor De Atención Médica Para El Proceso Del Candor Médico En Las Conversaciones (Health Care Provider Notice for Medical Candor Process)

  Acuse De Recibo Del Paciente De La Declaración Del Proveedor De Atención Médica Y Notificación Relacionada Con Una Oferta De Indemnización (Patient Acknowledgment of Health Care Provider Advisement and Notice Related to Offer of Compensation)

  Consentimiento Del Paciente Para Participar En El Proceso Del Candor Médico En Las Conversaciones (Patient Consent to Participate in Medical Candor Process)

  Preguntas Frecuentes De Los Pacientes Y Descripción Del Programa De La Ley De Candor Médico En Las Conversaciones De Utah (Utah Medical Candor Act Patient FAQs and Program Overview)