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AMA Note

Against Medical Advice education and departure.

For educational use only. Always verify with clinical judgment and facility protocols.

Against Medical Advice (AMA)

Documentation for AMA education and departure.

Capacity Assessment

Provider (MD/NP) Notified

Specific Risks Discussed

Alternatives Discussed

Patient Understanding

Form Status

Method of Departure

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EVENT: Departure Against Medical Advice (AMA) Patient expressed desire to leave facility against medical advice. Patient alert, oriented, and demonstrates decision-making capacity. Provider [Name] was notified and spoke with patient at length regarding risks. Patient educated on risks of leaving, specifically: Infection and worsening of condition. Alternative treatment plans discussed and declined by patient. Patient verbalized understanding of risks and consequences. Patient remains firm in decision. AMA form signed. Discharge instructions provided. Patient left unit via private vehicle.

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