Attachment 7 Against Medical Advice Form.docx

This file is an Against Medical Advice (AMA) Form template designed for use in healthcare settings. The form documents a patient's voluntary decision to leave a medical facility against their physician's recommendations, serving as a release of liability for the healthcare provider. The form requires the patient to acknowledge understanding of potential medical risks—including death, permanent disability, infection risks, and harm to an unborn fetus—as well as the medical benefits they are forgoing, such as diagnostic testing, imaging, laboratory work, medications, and potential hospital admission or follow-up care. The document must be signed by the patient, attending physician, and a witness, with all parties documenting the date of the signature.

This attachment appears to be part of a Health Services Contract documentation package for the Department of Homeland Security Federal Law Enforcement Training Centers (FLETC) Enterprise Health Unit Services solicitation (70LGLY26RGLB00005). However, the AMA form itself is a standard administrative template rather than a requirement specification or deliverable description. As a template document included in the contract file, it likely serves as guidance for healthcare service providers regarding proper procedures and documentation standards they must follow when managing patient care at the four FLETC Training Delivery Points located in Glynco, Georgia; Artesia, New Mexico; Charleston, South Carolina; and Cheltenham, Maryland.