Information for patients at Yachiyo Medical Center on Generalconsent to medical treatment
Yachiyo Medical Center provides fair, high-quality, safe medical care to our patients. We
also focus on developing healthcare professionals and conducting medical research,which are responsibilities for university hospitals. To facilitate our roles in healthcare,education and research, we ask our patients to consent to the items below:

1. Rights and responsibilities regarding medical care
• Your active participation and cooperation in your own treatment are appreciated.
• You must share accurate information with us about your own health.
• You have the right to express your wishes, in advance, regarding medical treatment
and terminal care, including life-prolonging treatment and organ donation.
• You have the right to know about treatment options proposed and/or recommended byyour doctor and ask questions if there is anything you don’t understand.
• You have the right to obtain a second opinion from another hospital to choose thetreatment option that you believe would be most suitable for you.
• If you are to undergo testing, treatment and/or surgery that will place a heavy burden
on your body, we will provide you with an explanation and ask you to sign an informed
consent form in advance. (This does not apply to emergencies where lifesaving
treatment is required.) For minimally invasive procedures such as blood testing, a nonwritten, oral explanation alone will be provided without asking your consent so as toensure smooth treatment procedures.
• Medical interns and trainee healthcare professionals may be engaged in treating you.
• You are required to follow hospital rules and regulations so that you can receive highquality medical care.
• Medicine is not a pure science. Please understand that all medical procedures such astreatment and testing are associated with risks.

2. Use ofsamples and information

generated by medical treatment• Information on your treatment and medical records will be used and provided for such
purposes as treatment, healthcare services, insurance claims, research and education.
• Tissues and body fluids such as blood and urine isolated from your body during surgery
or testing and treatment procedures may be preserved for such purposes as treatment,
research and education. They may also be discarded or used for testing.
• When the abovementioned samples are used for research purposes, we will obtainprior approval for each research project from the Tokyo Women's Medical University
Ethics Committee, the Ethics Review Committee on Genetic Analysis Research and/or
other review boards. When it is not required to obtain individual consent for research,relevant information will be posted on in-hospital notice boards and/or the website at
http://www.twmu.ac.jp/univ/about/research-corporation3.php.
• When the abovementioned samples are used for research and educational purposes,
data will be anonymized to prevent personal information from being identified by thirdparties. For details, refer to the Personal Information Protection Policy at
http://www.twmu.ac.jp/TYMC/policy.html.
• Samples will be used for research based on your voluntary agreement. In principle,
unless you express your intention not to participate in research, we will assume that youconsent to the use of your samples for the research.

3. Other items• Please pay your medical expenses without delay.
• Take care of your personal belongings and valuables. We are not responsible for any
theft or loss.
• We have surveillance cameras in the hospital for security reasons. We view videos
recorded by these cameras when necessary.

4. When you have inquiries
If you have any questions or comments regarding the information above, please contact
the Patient Service Office (ext. 2490) on the fourth floor of the Yachiyo Medical Center
Outpatient Ward. You can withdraw your consent upon reasonable notice as long as it
does not affect your treatment. Even if you withdraw your consent, you will suffer nodisadvantage in receiving treatment.