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Optimus Vascular is committed to providing safe, transparent, and legally compliant vascular access services. Below are the guidelines for downloading and using our Patient Consent Form for PICC line and Midline catheter insertions.
 
Facility staff may download our standard Patient Consent for PICC or Midline Insertion form by clicking the attachment here.
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Please print and complete this form prior to the scheduled procedure whenever possible.

Click here to download
consent form

When to Use the Consent Form
 
The consent form should be reviewed with the patient (or legal representative) prior to the procedure. The following information must be discussed:
 
  • The purpose of the PICC or Midline insertion
  • Benefits, risks, and alternatives
  • Post-procedure care expectations
  • That no outcome is guaranteed
 
Once reviewed, the patient or representative should sign the consent form in the designated section.
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Verbal Consent Protocol
 
If the patient is unable to sign (e.g., due to physical limitations or cognitive status), verbal consent may be accepted under the following conditions:
 
  1. The procedure must be explained in full to the patient or legal representative.
  2. The reason the patient cannot sign must be clearly documented on the form.
  3. Two facility staff members (e.g., nurse and supervisor) must be present to witness the verbal consent.
  4. Both witnesses must print and sign their names on the designated lines.
 
This process ensures legal compliance and protects both the patient and healthcare providers.
 
Retaining the Form
 
The completed consent form should be:
 
  • Included in the patient’s medical record at the facility.
  • A copy may be provided to Optimus Vascular upon request.
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Need Help?
 
If you have any questions about the consent form or vascular access procedures, please contact us directly at 630-819-0367 or 630-819-0109.
 
Thank you for partnering with Optimus Vascular in delivering safe and efficient vascular access services.
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1- PICC -1-Tree

Care That Grows Beyond The Bedside

At Optimus Vascular, every PICC line order helps us give back to the planet. For each procedure, we plant 1 tree through our sustainability partnership—because healing should extend beyond the patient to the world we share.

 

Better care. One PICC at a time. One tree at a time.

Expert Access — On Time, Every Time.

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