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Pennsylvania Department of Health Operations 111BLSAdult/Peds EMS Patient Refusal Checklist EMS Agency Date Time Patient Name Age Phone # Incident Location Incident # Situation of Injury/Illness Check.

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A good refusal narrative should document that multiple alternatives were given. If someone other than the patient is making the refusal decision, that person should be informed of the risks and consequences just as you would inform the patient.

(c) Staffing. The minimum staffing for a QRS is one EMS provider. If the QRS responds to a call with a BLS squad vehicle, intermediate ALS squad vehicle or ALS squad vehicle, the minimum staff shall also include an EMSVO, except that only one person is required if the EMSVO is also the EMS provider.

QRS stands for Quick Response Service and it provides seriously injured or ill individuals with trained emergency medical providers to provide medical treatment at a moments notice. This generally occurs prior to the arrival of an ambulance.

A) A competent adult or a competent emancipated minor has the right to determine the course of their own medical care including the right to refuse indicated treatment or ambulance transport. EMS personnel shall advise the patient of the risks and potential consequences of refusing indicated treatment or transport.

Documentation of a refusal should also include the following notations in the patient's record: Information the provider gave to the patient concerning the patient's condition and the proposed treatment or test. Reasons for the treatment or test should also be noted.

(a) Purpose. An EMS agency that operates a QRS uses EMS providers to respond to calls for EMS and provide EMS to patients before an ambulance arrives.

How to Write an Effective ePCR Narrative Be concise but detailed. Be descriptive in explaining exactly what happened and include the decision-making process that led to the action. ... Present the facts in clear, objective language. ... Eliminate incorrect grammar and other avoidable mistakes. ... Be consistent and thorough.

Documentation should include the following: The patient's capacity to understand the information being provided or discussed. Treatment was offered and refused. The reasons a patient refuses a treatment.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232