Refusal To Treatment Form - 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. Discussion and refusal of treatment. 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. Individuals are legally entitled to exercise their freedom of choice by choosing not to undergo a recommended course of treatment, medication, or testing. _____ i am provided with this refusal form and information so i may understand the recommended treatment and the consequences of refusing 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. 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 have chosen to decline the recommended test/treatment/procedure outlines above and accept the risks and consequences of my decision.
Discussion and refusal of treatment. Web refusal to consent to treatment, medication, or testing. 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. _____ i am provided with this refusal form and information so i may understand the recommended treatment and the consequences of refusing treatment. Having considered all of my options and understanding the risks of declining the treatment, medication, or testing, i have decided not. 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. I have chosen to decline the recommended test/treatment/procedure outlines above and accept the risks and consequences of my decision. 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.