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LUMINA
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HIPAA & E-SIGN Compliant

Digital Surgical Consent & Medical Waiver Pad

Sign surgical consent forms with touch/mouse stylus, recorded securely with biometric timestamps and instant EHR syncing.

Digital Surgical Consent & Medical Waiver

HIPAA & California Medical Board Electronic Consent (E-SIGN Valid)

Encrypted Vault

Informed Surgical Consent Notice:

I hereby authorize Dr. Alexander Wright, MD, DDS / Dr. Elena Rostova, MD and the surgical staff of Lumina Medical Institute to perform the procedure listed above. I acknowledge that I have been informed of the clinical benefits, surgical risks, alternative therapies, and post-operative recovery protocol.

✍️ Sign inside this box using finger, stylus, or cursor