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By signing below, i understand that my refusal to follow my providers advice and undergo the recommended test/treatment/procedure could. I, hereby acknowledge my declination of medical treatment and/or observation offered to me by_______________________for the injury or illness. I choose to refuse the recommended test/procedure/treatment and accept the risks and consequences of my decision. This form should be signed by the.
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My doctor has informed me of. By signing below, i understand that my refusal to follow my providers advice and undergo the recommended test/treatment/procedure could. I, hereby acknowledge my declination of medical treatment and/or observation offered to me by_______________________for the injury or illness. I choose to refuse the recommended test/procedure/treatment and accept the risks and consequences of my decision. This.
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I, Hereby Acknowledge My Declination Of Medical Treatment And/Or Observation Offered To Me By_______________________For The Injury Or Illness.
I choose to refuse the recommended test/procedure/treatment and accept the risks and consequences of my decision. My doctor has informed me of. This form should be signed by the patient or authorized party if he/she refuses any surgical procedure or medical treatment recommended by. By signing below, i understand that my refusal to follow my providers advice and undergo the recommended test/treatment/procedure could.
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