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Maryland EMERGENCY MEDICAL CARE REFUSAL FORM PARENT OR GUARDIAN COMPLETION (To be completed by parent or guardian of athlete who is under 18 years old or otherwise has a legal guardian) Instructions:

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How to fill out emergency medical care refusal

01

Start by clearly stating your intention to refuse emergency medical care.

02

Provide detailed reasons for refusing the medical care. Be specific and include any relevant medical history or conditions.

03

Clearly state that you understand the potential risks and consequences of refusing the medical care.

04

If applicable, provide the name and contact information of your designated healthcare proxy or emergency contact person.

05

Sign and date the refusal form in the presence of witnesses, if required by local regulations.

06

Keep a copy of the completed refusal form for your records.

07

Inform your healthcare provider about your decision to refuse emergency medical care and ensure they document it in your medical records.

Who needs emergency medical care refusal?

01

Individuals who have the capacity to make informed decisions about their own healthcare and fully understand the potential risks and consequences of refusing emergency medical care.

02

Individuals who have specific medical conditions or preferences that may make certain emergency medical interventions undesirable or unnecessary.

03

Individuals who have designated a healthcare proxy or emergency contact person to make decisions on their behalf in case of incapacitation.

04

Individuals who have discussed their refusal of emergency medical care with their healthcare provider and received appropriate guidance.

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What is emergency medical care refusal?

Emergency medical care refusal is a document that allows individuals to decline or refuse medical treatment in case of an emergency.

Who is required to file emergency medical care refusal?

Any individual who wishes to refuse emergency medical care is required to file an emergency medical care refusal.

How to fill out emergency medical care refusal?

Emergency medical care refusal can be filled out by providing personal information, medical history, reasons for refusal, and signature.

What is the purpose of emergency medical care refusal?

The purpose of emergency medical care refusal is to ensure that an individual's wishes regarding medical treatment are respected in case of an emergency.

What information must be reported on emergency medical care refusal?

Emergency medical care refusal must include personal information, medical history, reasons for refusal, and signature.

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