Waiver Rules and

Documentation Process


Patients who are mentally capable of making decisions are able to refuse medical care, even if the consequences of the refusal of care may be potentially harmful or even deadly.


  • The EMS employee shall ensure that the patient understands the contents of the waiver and is aware of the potential consequences of refusing medical treatment or transport.
  • If possible, the patient should be advised of said consequences in front of a witness.
  • Any non-emancipated minor who is between their sixteenth and eighteenth birthday may consent to health services, but may not refuse.
  • A minor who is married, pregnant (or has been pregnant), or independently living away from home may refuse treatment and/or transport.
  • Refusals of care and/or transport should be well documented in the PCR.


  • Waiver Rules


  • E — Educate
  • — Inform
  • O -- Offer Transport
  • U — Understand: Validate Understanding


  • The EMS Refusal Documentation Process:


  • C.A.S.E  C.L.O.S.E.D


  • Patient Refusal Narrative Documentation:


  • C = Condition, Capacity, and Competency
  • A = Assessment
  • S = Statements Made by the Patient
  • E = Educate
  • C = Consequences
  • L = Limitations of EMS
  • O = Offer Transport
  • S = Signatures and Initials
  • E = Educational Material
  • D = Dial 911 Again