MEDICATION REFUSAL FORM 2025

1. Click ‘Get Form’ to open the MEDICATION REFUSAL FORM in the editor.
2. Begin by entering the CLIENT NAME in the designated field at the top of the form. This identifies who is refusing medication.
3. Next, fill in the HOUSE # to provide additional identification for the client.
4. In the section labeled 'Medication', clearly list the medication you are refusing. Ensure accuracy to avoid any confusion.
5. Record the DATE and TIME OF REFUSAL in their respective fields. This documentation is crucial for medical records.
6. Sign in the 'Client Signature' field to formally acknowledge your refusal of medication.
7. Staff members should initial in the 'Staff Initials' section to confirm they witnessed this refusal.
8. Finally, add any relevant COMMENTS that may help clarify your decision or provide context for future reference.

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