Refusal To Treat Form - Web refusal to consent to treatment, medication, or testing. Having considered all of my options and understanding the risks of declining the treatment, medication, or testing, i have decided not. Discussion and refusal of treatment. Web by signing below, i understand that my refusal to follow my providers advice and undergo the recommended test/treatment/procedure could seriously impair my health or even result in death. I have chosen to decline the recommended test/treatment/procedure outlines above and accept the risks and consequences of my decision. I am being provided with this information and refusal form so i may better understand the treatment recommended for me and the consequences of my refusal. Web in situations in which it is difficult to obtain informed consent (emergencies, low health literacy) or informed refusal (patients leaving ama, refusing procedures), thorough assessments of capacity, multidisciplinary assistance, and clear documentation are key. Individuals are legally entitled to exercise their freedom of choice by choosing not to undergo a recommended course of treatment, medication, or testing. I have had an opportunity to discuss and ask questions concerning the recommendations and alternative treatment recommendations. Critical steps of informed consent.
I am being provided with this information and refusal form so i may better understand the treatment recommended for me and the consequences of my refusal. Web refusal to consent to treatment, medication, or testing. Individuals are legally entitled to exercise their freedom of choice by choosing not to undergo a recommended course of treatment, medication, or testing. Web by signing below, i understand that my refusal to follow my providers advice and undergo the recommended test/treatment/procedure could seriously impair my health or even result in death. I have had an opportunity to discuss and ask questions concerning the recommendations and alternative treatment recommendations. Having considered all of my options and understanding the risks of declining the treatment, medication, or testing, i have decided not. Discussion and refusal of treatment. I have chosen to decline the recommended test/treatment/procedure outlines above and accept the risks and consequences of my decision. Critical steps of informed consent. Web in situations in which it is difficult to obtain informed consent (emergencies, low health literacy) or informed refusal (patients leaving ama, refusing procedures), thorough assessments of capacity, multidisciplinary assistance, and clear documentation are key. _____ i am provided with this refusal form and information so i may understand the recommended treatment and the consequences of refusing treatment.