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MIDSTATE EMS Patient Refusal Form Patient name PCRRun - midstateems 2025

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The document is a Patient Refusal Form from Midstate EMS, which allows patients to refuse medical treatment or transport. It includes sections for patient information, details of the care being refused, and instructions for various medical conditions. The form emphasizes the patient's right to refuse care while ensuring they are informed of the potential risks involved. It also requires signatures from the patient and a witness to acknowledge understanding and acceptance of the refusal.

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What to do if a patient refuses help?

Listen Actively : Allow the patient to express their concerns and reasons for refusing care. Provide Information Address Concerns Explore Alternatives Assess Capacity Document the Refusal Respect Autonomy Follow-Up

How would you handle it if a patient refuses care?

Assess the Situation: Understand the reasons for the refusal. Provide Information: Ensure the patient has all the necessary information regarding the treatment, including benefits, risks, and alternatives. Listen Actively: Allow the patient to express their concerns or fears. Respect Autonomy: Acknowledge the patient

What should an EMS provider do if a patient refuses care?

A patients refusal of EMS treatment and/or transport must be: an informed refusal.

What must a patients refusal of EMS treatment and or transport be?

This fundamental right to refuse medical treatment is considered a negative rightthe right to not be touched and to be free from unwanted medical interventions. Overriding a decisional patients refusal is not ethically or legally permissible.

What should you do if a patient refuses treatment or transport at EMT?

You simply need to get a statement refusing treatment signed by the person that is injured. We carried them in the ambulance. If the person refused treatment and refused to sign, we simply had a police officer, another medic, a fireman, etc., witness the verbal refusal and sign the form that they heard the refusal.

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What is the EMTs role and obligation for patient refusals?

If a patient refuses treatment or transportation the EMT must 1st involve medical control and note the patients decision and why on your report. The patient will need to sign a refusal form and have a witness signature, if and only if no witnesses are available your partner may sign the form.

How do you document a patient refusal?

EMS personnel shall advise the patient of the risks and consequences which may result from refusal of treatment and/or transport. The patient should be advised to seek immediate medical care.

MIDSTATE EMS Patient Refusal Form Patient name PCRRun - midstateems 2025

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What to do if a patient refuses help?

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What should an EMS provider do if a patient refuses care?

What must a patients refusal of EMS treatment and or transport be?

What should you do if a patient refuses treatment or transport at EMT?

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What is the EMTs role and obligation for patient refusals?

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