This customizable document, Refusal of Blood/Blood Component Transfusion, is taken from MCN Healthcare's Emergency Department Policy and Procedure Manual. For more than 20 years, MCN has been the health care industry's leading provider of policy and procedure templates, forms, competencies and other compliance tools.

MCN provides more than 80 health care specific policy and procedure manuals for Acute Care Hospitals, Ambulatory Care, Behavioral Health, Home Health, Physician Practice, and Long Term Care. MCN's policy and procedure manuals focus on the latest healthcare "hot topic" issues related to patient safety and prevention of medical healthcare errors.

Here is some sample content from Refusal of Blood/Blood Component Transfusion:

	POLICY: It is the policy of Hospital to verify, by means of the Refusal To Permit Blood/Blood Component Transfusion Form, that the patient's informed refusal has been obtained by the treating physician after the patient has been informed of the possible risks and complications that may occur as a result of the patient's refusal to receive recommended transfusion of whole blood and/or frozen plasma, packed cells, platelets or cryoprecipitates. PURPOSE OF THE FORM: To ensure that the treating physician has obtained an informed refusal from the patient To provide the patient with the...
Second excerpt:
	...Hospital Personnel: Whenever the patient refuses blood ordered by the attending physician or a staff physician, the physician should be contacted immediately. Under no circumstances should an employee i.e., registered nurse attempt to obtain the patient's informed consent or informed refusal in such a situation. PROCEDURE FOR COMPLETING THE HOSPITAL FORM: Time and Date of Signature: The time and the date on the form should be the time and date the form is signed by the patient...