General Consent at St. Luke’s International University and Its Medical Facilities
Care at St. Luke’s medical facilities* involves various tests, procedures, treatments, etc. Each medical act is, in principle,conducted after explanation and consent (i.e. informed consent). However, acts believed to have little burden on one’s physicaland mental state and carry little risk are treated under those with overall confirmed consent (referred to as general consent) inorder to have a seamless progression in care and to smoothly implement education and research as an educational hospital. Basedon designated standards, the below medical acts, as decided by St. Luke’s medical facilities, are subject under general consent. If
you understand and consent to general consent, please sign the consent form. You may reject all or part of the below medical acts.
If you wish to do so, please inform us. Furthermore, even if you have consented previously, you may withdraw your consent at
any time. Please inform us should you wish to do so.
Also, first-time patients to this institution’s medical facilities prior to May 23, 2021 have not had their written consent for thebelow medical acts taken. Please notify our staff if you do not consent to any of these acts. If no notice is made, your care willcontinue under the assumption that you understand and consent to these acts.
High-risk medical acts and special medical acts including care for which you will bear the full medical fees will always be
conducted only after we have received written consent.
If you have any questions or concerns, please enquire with the Patient Consultation Office.
* St. Luke’s medical facilities includes: St. Luke’s International Hospital, St. Luke’s Affiliated Clinic, St. Luke’s Affiliated Clinic St. Luke’s MediLocus, St.
Luke’s Maternity Care Home, St. Luke’s International Hospital’s Home Visit Nurse Station, and St. Luke’s International Hospital Care Planning Center.

Medical acts subject under general consent
General items
Medical history taking, physical examinations, body measurements, blood pressure measurements, rehabilitation, nutritional
guidance, dietary decisions, repeated instructions on external accommodation, imaging of surgical or diseased sites, video
recording of tests, procedures, treatment, etc.
Tests and monitoring
Blood draws, blood tests, tests for hepatitis B, hepatitis C, and human immunodeficiency virus (HIV), urine tests, urinalysis,
microbiology tests, specimen pathological and cytological tests, physiological function tests (electrocardiogram, pulse wave,
pulmonary function, electroencephalogram, ultrasound, respiratory function, expired gas analysis, electromyogram, etc.), bodycomposition analysis, general X-ray imaging, quantitative bone mineral tests, X-ray fluoroscopy, non-contrast CT, nuclear
medicine (RI) scan, higher-order function tests, psychological examinations, various monitoring (electrocardiogram,transcutaneous oxygen saturation measurement, arterial pressure, respiration, brain wave monitor, neuromuscular monitor, fetalheart monitor, etc.), intracutaneous reaction tests (patch test, intradermal test, scratch test, Mantoux test, minimal erythema dose(MED) test, etc.), skin allergy tests, fiberoptic nasopharyngoscopies/laryngoscopies, ophthalmological tests, uroflowmetries, postvoid residual urine tests, 24-hour pH measurement, anoscopies, hysteroscopy, neonatal transcutaneous bilirubin concentration
measurement, confirmation and maintenance of implantable devices
Procedures and treatment
Insertion/placement of peripheral intravenous line, insertion/placement of continuous subcutaneous line, insertion/placement of
peripheral intra-arterial line, oxygen administration, surgical site procedures, wound procedures, skin incision (pus drainage),debridement, skeletal traction via steel wire, indirect traction, joint procedures (e.g. arthrocentesis), dislocation reduction, noninvasive reduction and fixation, foot care, casting and cast removal, compress procedures, anti-inflammatory procedures, elastic
stocking use, attachment of intermittent air compression pump for lower limbs, trigger point pain treatment, nerve block, suctionof phlegm, etc., nebulizer procedures, insertion/placement of nasal catheter, insertion/placement of bladder catheter, testing andtreatment for cavities, gum disease, and dentures, oral care, nose bleed arrest, myringotomy, tympanostomy tube insertion, removalof foreign bodies from nasal canal, ear canal, and throat, incision/centesis of abscess around the tonsils, gastric tube
insertion/placement, enema, cleansing enema, hemorrhoid removal and ligation, rectum bougie, anal abscess incision and centesis,
manual reductions of incarcerated hernia, ophthalmological procedures, pessary, intrauterine device (IUD) insertion, neonatal
navel procedures, hypothermia therapy for neonatal asphyxia, cold and warm compresses

Drug administration
Pharmaceutical prescriptions, normal drug administration (including noninvasive administration methods not done orally),
injections (e.g. subcutaneous, intramuscular, and intravenous injections, and continuous drips), local anesthesia for general care
Miscellaneous
Participation of practicum students and residents in your care, use of medical information within St. Luke’s medical facilities, atSt. Luke’s International University conferences, etc., use of medical information for educational and research purposes (if used inthis case, we will strictly comply with the Personal Information Protection Policy, Ethical Guidelines for Medical Research
Involving Human Subjects, and other stipulations and guidelines).