Mercy Memorial Hospital System

AGAINST MEDICAL ADVICE RELEASE FORM PROCEDURE

The Against Medical Advice Release form of the Monroe County Medical Control Authority should be used as the document of last resort in the event of a patient refusing medical treatment (or part of treatment) or transportation to a medical facility. If the patient requires medical treatment, in the opinion of the EMT or the on-line Medical Control physician, then the EMT should assure that the patient under-stands the need for treatment, the nature of the medical problem, and the possible complications of not receiving treatment. The AMA form (see AMA attached) must then be signed by the patient and by at least two witnesses.

In the event that the EMT encounters a patient that refuses treatment, the following procedures should be followed prior to obtaining the patient's signature on the Against Medical Advice Release form.

1. Document the patient's ability to comprehend the verbal information concerning the present medical condition as described. (See assessment portion of AMA)

2. Inform the patient of the problem, or your perception of the problem, and document this information on the run report.

3. Inform the patient of the complications and consequences of not seeking medical treatment and document this information on the run report.

4. Contact Medical Control and explain the situation as it exists at present.

5. Explain any additional information that Medical Control has provided to the patient, and document the patient's ability to understand the information.

6. Suggest possible alternatives to the patient, such as seeking the assistance of a family member to help in obtaining medical treatment.

7. If the above procedures do not convince the patient to seek medical assistance, then have the patient sign the Against Medical Advice Release form. Also attempt to solicit a signature of acknowledgement of the patient's action from the nearest relative, parent or guardian present and another signature from a competent witness to both the above signatures, with both address and contact numbers for the witness. Assure that the name and address information and signatures are legible.

8. If the patient or the parent/guardian, in the judgment of the provider and/or Medical Control, appears to be unable to completely comprehend treatment or ramifications of refusing treatment either due to impairment by drugs, alcohol, mental ability or medical condition, then release against medical advice cannot be allowed.

Date Revised:1/99 Medical Control Approved:1/99  EMS Division Approved:9/99

 

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