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CLINICALGUIDELINES CG24PATIENTREFUSALPage1of3 LastRevision: 03/23/2017ThepurposeofthisguidelineistoprovideEMSpersonnelwithclearrulesformanagingsituationsin whichthepatientorthepatientsrepresentativedeclinesorrefusescareortransportationbyEMS.
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How to fill out refusalnontransportstatementdocumentingformfactthaformwasofferedspecifictreatmentand
How to fill out refusalnontransportstatementdocumentingformfactthaformwasofferedspecifictreatmentand
01
Start by obtaining the refusalnontransportstatementdocumentingformfactthaformwasofferedspecifictreatmentand. This form may be provided by the healthcare provider or can be downloaded from a reliable source.
02
Read the form carefully to understand the information it requires and the purpose of each section.
03
Begin by filling out the patient's personal information section. This may include their full name, date of birth, address, contact information, and any other necessary details.
04
Next, provide details about the specific treatment that was offered to the patient. Include the date and time of the offer, the nature of the treatment, and any relevant details mentioned in the form.
05
The form may require the patient to indicate their decision regarding the offered treatment. Follow the instructions provided to clearly document the patient's refusal or acceptance.
06
If the patient refused the specific treatment, provide a brief explanation or reason for their decision. This can help healthcare providers understand the patient's perspective.
07
Double-check all the information filled in the form for accuracy and completeness.
08
Once everything is filled out correctly, sign and date the form to validate it.
09
Submit the completed form to the designated healthcare provider or follow the instructions provided for submission.
10
Keep a copy of the form for your records.
Who needs refusalnontransportstatementdocumentingformfactthaformwasofferedspecifictreatmentand?
01
Refusalnontransportstatementdocumentingformfactthaformwasofferedspecifictreatmentand is typically needed in situations where a healthcare provider offers a specific treatment to a patient, but the patient refuses to undergo that treatment.
02
This form is commonly used in medical settings, such as hospitals, clinics, emergency rooms, and doctor's offices.
03
Patients who have been offered specific medical treatments but choose to decline them may be required to fill out this form.
04
Additionally, healthcare providers may also need this form to document the patient's refusal and to maintain accurate medical records.
05
It is advised to consult with healthcare professionals or the specific healthcare institution for detailed guidelines on who needs this form in a particular situation.
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