Your form is very condescending. Trust me, the hospital staff is well aware of what jaundice is and does not need you to explain it to them.
Are you aware that you don't need to be making up all these "forms?" Just don't consent to what you don't want in the hospital.
Although for the life of me I can not imagine why someone would not want their child's bilirubin level checked. It's not even a blood test. They shine a light on the skin and test it that way. Kernicturus leads to permanent brain damage. Why risk it?
The onus on informed consent is on the care provider, not the patient. My thinking would be that they need to present YOU with a form that lists the benefits/consequences of each procedure, not the other way around. I think if a provider is going to pressure you to do something (or even suggest it), they will not be less likely to do so because you submitted a form.
Lora, Mommy to L & C and birth photographer extraodinaire www.loradentonphotography.com
Consent should be spelled without the second "c".
I read a few of your other threads. Certainly if this is what you think you need for your particular hospital/care providers, go ahead, but we refused heb b, vit k, and the eye stuff and they just handed me a quick paper to fill out. It was not the scary your baby could die paper, just said I was refusing it. No one said a word about it. I did have my paperwork showing I was heb b negative plus my daughter's doctor gave me a note saying he knew we did not want her vaxxed, just in case they gave us trouble but it was all fine. But I know not everyone is going to have the same experience.
Our daughter was given the blood test. They never said anything about any light test and she was never taken from me.
You do not need to make up your own consent forms. The burden of proof that you understand procedures does not fall on you, the patient. You don't need to prove to them that you understand. They need to prove to *you* that they have explained procedures to you adequately.
These forms are a little bit silly. Just give them a list of stuff you're not allowing, and ignore them if they give you grief. I refused to be induced for 12 hours in a hospital, and they just asked me to agree that I knew I was taking a risk. I said I did, and they left it at that.