Delaware Handbook: Informed Refusal

A PATIENT REFUSES TO FOLLOW THE TREATMENT PLAN I HAVE PRESCRIBED FOR HIM, WHAT SHOULD I DO? A patient who refuses to follow your treatment plan can be a liability. In such situations, it is crucial that you fully educate the patient on the risks and consequences of refusal and document your efforts. This discussion and the patient’s refusal should be documented in the medical record, and the patient should sign an informed refusal form. The following should be documented: consequences of refusal (risks and complications), advice given to the patient, instructions given regarding follow up, names of all persons involved in the refusal process, patient’s condition, statement that the patient has decided against the treatment, including reasons for refusal, and patient’s confirmation that the potential consequences of the refusal are understood. The elements of the refusal form are identical to those of the consent form, except that the form will end with the pa...
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