English to Russian Medical Medical: Pharmaceuticals

Statement to Permit Treatment: I consent and authorize this agency; it’s agents/associates to provide care and treatment to me for
this home care admission. I have been fully informed of the assessment and evaluation of my home care needs and the risk of declining
these services if I decide to do so. I accept the proposed Plan of Care in accordance with the orders of my physician. I understand that
my treatment plan may change and if so this will be discussed with me. I further understand that I and/or my family/caregiver will receive
instructions to assist with my care and that my care will therefore become my responsibility in the absence of agency staff.