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Get Disposition Form - Winston-salem Rescue Squad - Winstonsalemrescuesquad

USAL This section only applies if this box is marked The Paramedic has recommended: o Measuring the patient s blood pressure o A backboard and neck collar for the patient o Ambulance transportation for the patient o o o o o A complete physical exam of the patient Giving the patient oxygen Starting an IV for the patient Giving the patient medicine Other I refuse the care that the Paramedic has recommended. I understand that my refusal.

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