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Ambulance Refusal Form

Ambulance Refusal Form

Use a Ambulance Refusal Form 0 template to make your document workflow more streamlined.

That you could suffer serious complications or even death from conditions that are not apparent at this time. By signing below you are acknowledging that EMS personnel have advised you and that you understand the potential harm to your health that may result from your refusal of the recommended care and you release EMS and supporting personnel from liability resulting from refusal* PLEASE CIRCLE THE FOLLOWING THAT APPLY I refuse EVALUATION TREATMENT TRANSPORT IF YOU CHANGE YOUR MIND AND DESIRE...
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