As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Home Care Corporate Compliance Manual includes this customizable template, Discontinuance of Service Against Medical Advice Form. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more.

Health care organizations around the world utilize MCN’s compliant ready templates and workflow process tools to help them meet the latest changes in regulations and standards.

Here is some sample content from Discontinuance of Service Against Medical Advice Form:

	DISCONTINUANCE OF SERVICE AGAINST MEDICAL ADVICE This is to certify that at my own insistence, and against the advice of the organization and my attending physician, I have been informed by them of the dangers of discontinuing the home care services at this time. I release the organization, its employees and officers and my attending physician from all liability for any adverse results caused by my discontinuing the service prematurely. Patient/Legal Representative Signature: Date: Witness Signature: Date: Organization Representative Signature: Date: Patient Name: Patient Address:...
Second excerpt:
	... Date: Patient Name: Patient Address: Patient Phone Number: Reference...