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Michigan
General Procedures
REFUSAL OF CARE; ADULT AND MINOR
Date: July 18, 2014
Page 1 of 4
Refusal of Care; Adult & Minor
Purpose:
transport.
To provide the process for EMS personnel interacting
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How to fill out refusal of care adult

How to Fill Out Refusal of Care Adult:
01
Begin by providing the necessary information: Write your full name, date of birth, address, and contact information at the top of the form.
02
Specify the date: Indicate the date when you are completing the refusal of care form.
03
State your decision clearly: In the main body of the form, clearly state that you are refusing care as an adult. Use clear and concise language to make your decision known.
04
Include your reasons (optional): If you feel it is necessary, you can briefly explain the reasons behind your decision to refuse care. This can help medical professionals understand your perspective.
05
Sign and date the form: At the bottom of the document, sign your name and include the date of completion. This indicates that the refusal of care is intentional and made willingly.
06
Witness signature (optional): Some jurisdictions require a witness signature to validate the refusal of care. Check your local regulations to see if this is necessary.
07
Keep a copy: Make sure to keep a copy of the filled-out refusal of care form for your records. It can be helpful to provide copies to family members or healthcare providers involved in your care.
Who Needs Refusal of Care Adult?
01
Adults of legal age: Any adult who is of legal age has the right to make decisions about their own medical care. Therefore, anyone who wishes to refuse care as an adult may need to fill out a refusal of care form.
02
Individuals with specific preferences or beliefs: Some individuals may have specific preferences or beliefs regarding medical treatments or interventions. They may choose to complete a refusal of care form to ensure their wishes are respected.
03
Those with advance directives or living wills: Individuals who have already created advance directives or living wills may include a refusal of care as part of their overall healthcare decision-making documents.
Remember, it is important to consult with legal professionals or healthcare providers to ensure that you are following the appropriate regulations and guidelines when filling out a refusal of care form.
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What is refusal of care adult?
Refusal of care adult is a legal document that allows a competent adult to refuse certain types of medical treatment.
Who is required to file refusal of care adult?
Any competent adult who wishes to refuse medical treatment is required to file a refusal of care adult.
How to fill out refusal of care adult?
Refusal of care adult can be filled out by stating the specific medical treatments the individual wishes to refuse and signing the document in the presence of witnesses.
What is the purpose of refusal of care adult?
The purpose of refusal of care adult is to ensure that an individual's wishes regarding medical treatment are respected, even if they are unable to communicate them at the time.
What information must be reported on refusal of care adult?
Refusal of care adult must include the individual's name, date of birth, specific treatments being refused, and the signatures of the individual and witnesses.
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