Generic drugs consent form

Drafting a consent before providing medical treatment. This is regarding the responsibility/liability related to prescribing a drug.
Is the approach realistic and acceptable? 

I Dr ________,would like to inform you that I am prescribing you medicines in the generic

name  according to the guidelines of the MCI , WHO and various govt bodies etc in your best interest and to my best knowledge.

I would like to inform you that there are basically two types of  drugs manufactured one innovator or research molecule and the other group called generic drugs.

I would also like to inform you that there is one innovator drug Brand and many generic brands .

The innovator drugs are generally expensive if it is not in the essential drug  price control.

I would like to also inform you that I am not liable for the side effects ,reaction etc which these drugs may cause other than the known side effects .

I am also not liable
For the efficacy of the drug

For the quality of the drug

For the  potency of the drug

For the impurities that may be present

For any resistance that you may develop

Whether they are counterfeits

Whether there are any other adverse reaction

It is the responsibility of

MCI

FDA

Drug Company

The dispensing pharmacist ,pharmacy or hospital and policy makers.
I have no role in the selection of these drugs nor can I influence the hospital ,pharmacy ,pharmacist , patient over the choice of drugs.
I am not liable for Any medico legal cases that may occur in the future concerning the concerned drugs and all such queries etc should be directed to the above responsible parties.
It is entirely your responsibility which drug brand you choose and I will not be liable for the same.

For full information on innovator drugs brand name and generic company there are lots of online website were you can get the information.or you can ask the pharmacist who will/should give you the said info.
If after reading this you give me consent then I will prescribe you medicines with a Belief  and  knowledge that it will

/ may help you in the course of treatment .

Please mark below what type of drugs you would prefer. .
Thanking you. For placing your trust and health in my hands.

Dr.___________

Degree:_______                        Sign:

Reg no:________

Council: _______                            Patient’s name:

______________                                                Date:__________

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