Against Medical Advice Template: Safeguarding Autonomy & Liability

Introduction: When Patients Say No

Patients have the right to refuse treatment, even if that decision carries serious risks. An Against Medical Advice (AMA) discharge occurs when a patient leaves contrary to their physician's recommendation. The AMA Template is a critical tool to document this event, ensuring the patient's choice is informed and the provider's duty is fulfilled.

Why AMA Documentation is Essential

Proper documentation serves vital functions:

• Patient Safety: Forces a structured conversation about specific risks (e.g., sepsis, death), giving the patient one last chance to reconsider.
• Legal Protection: Creates a record that the physician met their duty of care by informing the patient of consequences.
• Capacity Check: Documents that the patient was mentally competent to make the decision at that times.
• Continuity: Provides discharge instructions and "return precautions" so the patient knows how to seek help if they change their mind or worsen.

Key Components of an AMA Form

A defensible AMA form must include:

• Capacity Statement: Affirmation that the patient is alert, oriented, and understands the situation.
• Risks Explained: Specific, documented risks (not just "bad things could happen," but "risk of permanent loss of limb").
• Alternatives Offered: Evidence that less intensive options were offered but refused.
• Patient Signature: Acknowledgement of the decision.
• Witness: Usually a nurse or another provider.

Complete Against Medical Advice Form

DISCHARGE AGAINST MEDICAL ADVICE (AMA)

Patient: [Name] | MRN: [Number] | Date: [Date/Time]

1. Capacity Assessment:
I attest that I have evaluated the patient and determined they have the decision-making capacity to understand their medical condition, the risks of leaving, and the alternatives.

2. Medical Advice Provided:
The patient has been diagnosed with/suspected of having: [e.g., Unstable Angina].
I have recommended: [e.g., Admission for cardiac monitoring and catheterization].
I have explained that this treatment is necessary to: [e.g., Prevent heart attack].

3. Risks of Leaving AMA:
I have informed the patient that leaving may result in serious harm, including but not limited to:
[ X ] Worsening of condition
[ X ] Permanent Disability
[ X ] Death
[ X ] Specific Risk: [e.g., Cardiac Arrest outside hospital]

4. Patient Acknowledgement:
I, [Patient Name], acknowledge that I have been fully informed of the risks designated above. I understand that I am leaving against the advice of my attending physician. I accept full responsibility for any consequences resulting from this decision. I understand I am welcome to return at any time.

Patient Signature: ____________________ Date: ________
Witness Signature: ____________________ Date: ________

5. Physician Statement:
I have explained the above to the patient. Despite my efforts to encourage them to stay, they have chosen to leave. Discharge instructions and prescriptions [were/were not] provided.

Physician Signature: __________________
[Dr. Name]

Protecting Practice Integrity with HealOS

When an AMA situation arises, speed and accuracy are key. HealOS agents assist:

• AI Medical Scribe: Captures the tense AMA discussion word-for-word, documenting exactly what risks were explained and the patient's specific responses, providing a superior legal record than a summary form alone.
• Regulatory Compliance Agent: Ensures the discharge documentation meets hospital policy and legal standards for informed refusal.
• EHR Interoperability Agent: Immediately files the AMA form and discussion notes into the permanent record.

Automated Workflow Diagram (Mermaid)

graph TD
    A[Patient Requests to Leave] --> B[Physician Assesses Capacity];
    B -- Lacks Capacity --> C[Intervention/Psych Hold];
    B -- Has Capacity --> D[AMA Discussion Initiated];
    D --> E[HealOS AI Scribe Records Risk/Benefit Conversation];
    E --> F[Physician Generates AMA Form via HealOS];
    F --> G[Patient Signs Form];
    G --> H[HealOS Compliance Agent Audits Record];
    H --> I[Discharge Complete & Filed];

Frequently Asked Questions (FAQs)

Document with Confidence using HealOS

High-risk discharges require high-quality documentation. Use HealOS AI agents to ensure your AMA records are unimpeachable and your patients are fully informed.

Explore HealOS Agents

Example Letter Template