High-Risk Documentation · 14 min · EMT

Refusal Academy

Refusals are high-risk documentation. Capture capacity elements (oriented, understands risks/benefits/alternatives), specific risks explained, offers made (transport, eval, ALS), patient decision in their words, witnesses, and follow-up advice.

Tiers: simple low-acuity refusal vs high-risk (chest pain, syncope, peds guardian, intoxication). Training only—follow agency policy and medical direction.

Good snippet

Patient AOx4, explained risk of MI/arrhythmia including death; offered ED eval and ALS. Patient stated, "I will not go." Friend present as witness. Advised call 911 if symptoms worsen; signature on refusal form.

Weak snippet

Pt refused. AMA. Left scene.

3-question check

0/3 answered

1. A refusal pack should include:

AOnly "AMA"BCapacity, risks explained, offers, decision, witnesses/adviceCOnly mileageDOnly ECG

2. High-risk refusals need:

ALess detailBMore explicit risk discussion documentationCNo quotesDNo witnesses

3. NarrativeCoach refusal content is:

ALegal adviceBTraining aid—follow agency/OLMC policyCA signed court orderDCE credit

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Lessons · Drills · HandoffNote

NarrativeCoach is a training aid only — not a medical device, not legal/billing advice, not an ePCR, and not CE/CAPCE. Never enter real PHI. Fictional scenarios only.