Aesthetic Pass · workflow design resource
Botulinum toxin consent-form provider checklist
Use this blank checklist to approve the structure, ownership and evidence path for a treatment-specific consent workflow. Do not enter patient information into this downloaded planning copy.
1. Record identity and visit scope
- Patient and practice record reference
- Visit, consultation and proposed treatment date
- Treating aesthetic provider and role
- Location and communication support
2. Current history and professional review
- Fresh anamnesis completion date
- Changes since the previous visit
- Previous botulinum toxin treatment context
- Items requiring clarification
- Provider review status
3. Proposed treatment context
- Treatment category and purpose
- Product or product category
- Planned treatment areas
- Patient goals and priorities
- Alternatives discussed
4. Information and questions
- Provider-approved information title and effective date
- Current product-labeling source
- Expected course, benefits, material risks and aftercare topics
- Patient questions and provider clarification
- Route for additional questions
5. Separate decisions
- Proposed treatment
- Clinical photography
- Publication or promotional photography
- Marketing contact
- Consequence of declining each optional purpose
6. Patient and provider actions
- Patient decision, signature and timestamp
- Provider review, signature and timestamp
- Witness or interpreter attribution where required
- Final status
- Correction or amendment route
7. Treatment-record continuation
- Actual product and practitioner-entered lot
- Treatment areas, injection map and point values
- Optional treatment-linked photos
- Aftercare and follow-up record
- Authorised retrieval and patient-access route
Approval gate
Clinical content approved by on . Privacy / records workflow approved by . Next review due .