the Refusal to Permit Medical Treatment

[Guest guest]

I wanted to know what anyone's thoughts are on signing the " Refusal to

Permit Medical Treatment " form from the hospital.? I know about not

signing the AAP form when declining vaccines etc. But from my research,

they might have us sign a " refusal to permit medical treatment " when

refusing the vit. k shot/antibiotic eye ointment when our baby is born.

TIA ~

Here is the form:

Refusal to Permit Medical Treatment

PATIENT

________________________________________________________________________

AGE ____________

I have been advised and it has been recommended by my physician Dr.

__________________________________

that I, or a person for whom I am the legal guardian, undergo the

following test(s), treatment(s),

operation(s) or procedure(s):

My physician has satisfactorily explained the above test(s),

treatment(s), operation(s) or procedure(s)

to me, the risks and benefits of this recommendation, the alternatives

to this recommendation and

the probable consequences of not receiving the test(s), treatment(s),

operation(s) or procedure(s). In

addition, I have had the opportunity to ask questions about the proposed

recommendation and have

had these answered to my satisfaction.

Notwithstanding the recommendation of my physician and with the

knowledge I have regarding this

recommendation, I have decided NOT to accept/permit the test(s),

treatment(s), operation(s) or

procedure(s) listed above. I understand that my failure to follow my

physician's advice may seriously

affect my health or the health of the person under my guardianship.

By signing below, I assume responsibility for all the risks and

consequences of my refusal. I also release

Dr. __________________________________________________ and other persons

participating in my care or that of

the person under my guardianship from all responsibility for any

unfavorable or bad results that may

occur as a result of my refusal to accept/permit the proposed

recommendation.