Patient Informed Consent / Refusal (Oregon Department Of Corrections) (Page 3 of 8) in pdf

Provide the completed form to the inmate to sign and date in the presence of a

health services witness.

In the presence of the inmate, the witness is to sign and date the treatment

refusal form.

If the inmate refuses to sign the form, the witnessing health services staff is to

sign and date the form indicating the inmate’s refusal to sign.

The health professional will document the information provided, circumstances,

and the inmate's stated reason for refusal in the progress notes of the health

care record.

The completed treatment refusal form is then filed in the health care record in

the Consents section. Forward the health care record to the Chief Medical

Officer, or designee, for clinical review.

The Chief Medical Officer, or designee, will review the circumstances and clinical

consequences of the inmate's treatment refusal. If the refusal presents

significant adverse health risks, schedule the patient for a subsequent

appointment with the provider to discuss the refusal. A corresponding progress

note will be written in the health care record. If adverse health risks are

expected, the refusal is to be noted on the health care record problem list.

An inmate may rescind a treatment refusal at any time by notifying Health

Services and consenting to recommended health care and/or treatment. Enter

the inmate's stated decision to rescind treatment refusal and circumstances into

the progress notes. If the treatment is identified on the problem list, note the

date of rescinding refusal in the resolved column.

If the inmate is rescinding refusal for health care and/or treatment that is

significant, initiate the procedure to obtain written informed consent.

If an inmate refuses health care and/or treatment that place others in the

institution at risk of infectious disease, the inmate is to be appropriately isolated

as per P&P #P-B-01.1, Isolation Control Precautions.

Health care professionals shall periodically discuss the recommended treatment

or care with an inmate whose refusal has significant adverse health risks or

consequences

Mental Health Informed Consent and Right to Refuse

All examinations, treatments and procedures are governed by informed consent

practices. Information is confidential and not shared outside Health Services

without written consent.

Exceptions are governed by informed consent practices outlined by mental

Page 3 of 4

Patient Informed Consent / Refusal (Oregon Department Of Corrections) Page 3