This customizable document, Refusal of Blood/Blood Component Transfusion, is taken from MCN Healthcare’s Outpatient Surgery and Ambulatory Services 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.

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 Refusal of Blood/Blood Component Transfusion:

	POLICY: It is the policy of this facility 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 attending and/or 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 attending and/or treating physician has obtained an informed refusal from the patient To...
Second excerpt:
	...It is the exclusive duty and responsibility of the attending and/or treating physician to provide information and to obtain informed consent. In the event that the patient refuses to give consent for the proposed blood/blood component transfusion, the physician has a duty to give the patient all the information that is relevant to a meaningful decision sufficient for the patient to understand the potential consequences of declining a blood/blood component transfusion. A valid...