DA Form 5009. Medical Record - Release Against Medical Advice

Form DA 5009 is a Medical Record - Release Against Medical Advice. This form is used by medical facilities and personnel to document a patient's decision to leave a medical facility against the advice of medical professionals. The purpose of this form is to ensure that the patient understands the risks and consequences of leaving medical care prematurely and to release the medical facility from any liability related to the patient's decision.

The form consists of sections where the patient or their legal representative provides their consent for leaving the medical facility against medical advice. The form may also include sections for documenting the patient's reasons for leaving and any instructions or recommendations given by the medical staff before the patient's departure.

Important fields in this form include accurate and clear documentation of the patient's decision and their understanding of the potential risks associated with leaving medical care prematurely. It is crucial to obtain informed consent from the patient or their legal representative to protect the medical facility from any legal implications that may arise from the patient's decision.

Application Example: A patient decides to leave the hospital against medical advice despite the doctor's recommendation for continued care. The medical staff uses Form DA 5009 to document the patient's decision, ensure they understand the risks involved, and release the medical facility from any liability arising from the patient's choice.

Related Forms: There may be other forms used to document patient consent and decisions related to medical care and treatments.