The following standard describes how a patient may make an informed decision to accept or refuse evaluation, treatment and/or transport.




All patients are presumed to have a condition requiring evaluation, treatment, and transportation to the closet appropriate ED. Patients have the right to refuse part of all of the evaluation treatment, and transport if they have decisional capacity.




  • Evaluate patient to the fullest extent indicated and determine if the patient is the appropriate medical decision maker.
  • If the patient does not appear to have decision capacity, proceed with evaluation, treatment, and transport under implied consent.
  • If the patient appears to have capacity, he or she may refuse all or part of the indicated evaluation treatment recommended, and transport destination.
  • If the patient has questionable decision-making capacity ,complete the capacity assessment in PCR.
    • If the patient passes the assessment, her or she may refuse treatment.
    • If the patient fails, proceed under implied consent.
  • In cases involving third-party consent, ensure the responsible party has decisional capacity prior to allowing decisions to be made on behalf of the patient.
    • Document the third party's relationship to the patient.
    • If there is doubt as to whether or not the third party is acting in the patient's best interest (e.g., abuse or neglect), immediately involve law enforcement.
  • Documentation for a patient refusing services must include at a MINIMUM:
    • The benefits of allowing care
    • The risk of refusing care including severe complications or death
    • The alternatives explained and offered
  • Attempt to ensure the patient is left in a safe location.


Medical Control


  • Contact medical control if:
    • After passing the capacity assessment, doubt remains as to the patient's decisional capacity, or if the patient's current medical condition (e.g. hypotension, hypoxia, head injury, etc.) calls into question decisional capacity.
    • Other unusual situations where the correct course of action is not apparent based on the criteria of this standard.