At Speedy Template, You can download Refusal of Care Against Medical Advice . There are a few ways to find the forms or templates you need. You can choose forms in your state, use search feature to find the related forms. At the end of each page, there is "Download" button for the forms you are looking form if the forms don't display properly on the page, the Word or Excel or PDF files should give you a better reivew of the page.
Refusal of Care Against Medical Advice
Criteria for refusing care
The patient meets all of the following:
1.Is a patient over the age of 18 yrs.
2.Exhibits no evidence of:
Altered level of consciousness
Alcohol or drug ingestion that would impair judgment
3. Understands the nature of the medical condition, as well as the risks and consequences of
1.Acknowledgement of Information(Initial on line)
a.____I have been advised that medical care on my behalf is necessary, and that
refusal of care and assistance could be hazardous to my health, and under
certain circumstances, including disability or death.
b.____I acknowledge that I may have a medical problem which may require
additional medical attention, and that NDSP or an ambulance is available to
transport me to the hospital. Instead, I elect to seek alternative medical care
and/or refuse further evaluation, treatment and/or transport.
2.Release of Liability (initial on line)
____ By signing this form, I am releasing University Health Services, Notre Dame,
of any liability or medical claims resulting from my decision to refuse care against
Ihave read and understand the Acknowledgement of Information and Release of Liability.
Speedy Template provides all kinds of legal templates, forms and waivers in different editable formats. Use the template search on the top to find the customized templates that fit your needs with absolutely no cost. Those templates are collected online so we do not claim the ownership of those templates. You can think this website as a legal document search portal and use it to find the printable templates and download them to your local computers and make appropriate adjustments from your end. There is no need to create an account or provide your credit card information. Feel free to download those Word, Excel, PowerPoint or PDF files while we continue to improve this website. Hope you can find those free printable templates useful for business or personal purposes.