Get Ny Midstate Ems Patient Refusal Form

This guide provides a clear and concise overview of how to successfully complete the NY Midstate EMS Patient Refusal Form online. It is designed to support users through each step of the process, ensuring that all necessary information is accurately provided.

Follow the steps to fill out the NY Midstate EMS Patient Refusal Form online

1. Press the ‘Get Form’ button to access the NY Midstate EMS Patient Refusal Form and open it in your chosen online editor.
2. Enter the patient’s name as it appears on their identification document.
3. Complete the PCR/Run number associated with this service incident.
4. Fill in the date and time of service accurately.
5. Input the EMS agency name providing the service.
6. Provide the printed name and identification number of the EMT assisting.
7. In the required field, specify the base station physician contact if the 'Other' option is selected.
8. Indicate the care that the patient refuses by checking the relevant boxes, including options such as blood pressure check, medication, neck collar, IV, and oxygen.
9. Ensure the responsible party signs the form acknowledging their refusal of treatment and understanding of the instructions provided.
10. Check the appropriate boxes for universal instructions based on symptoms, and ensure the patient signs in the designated area.
11. Complete the witness section, where an observer confirms that the patient was alert and understood the refusal.
12. Once all information is accurately filled, you can save the changes, download, print, or share the completed form as necessary.

Take the opportunity to fill out the necessary documents online today.