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Lama

The Leave against Medical Advice (LAMA) form is a document that patients or their attendants sign to acknowledge understanding of the risks associated with leaving the hospital against medical advice. It includes sections for patient information, doctor's details, and signatures from both the patient and a witness. By signing, the patient assumes full responsibility for any adverse outcomes and releases the hospital and its staff from liability.

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vikash
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1K views1 page

Lama

The Leave against Medical Advice (LAMA) form is a document that patients or their attendants sign to acknowledge understanding of the risks associated with leaving the hospital against medical advice. It includes sections for patient information, doctor's details, and signatures from both the patient and a witness. By signing, the patient assumes full responsibility for any adverse outcomes and releases the hospital and its staff from liability.

Uploaded by

vikash
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Leave against Medical Advice (LAMA) Form

S.No............................... Date............................

Name of Patient..................................................... I.P. No. .................. Room/Bed No. ..........................

I, Mr. /Ms ................................................................, S/o / D/o / W/o.............................................................


(Patient / attendant of patient)

Have been fully explained the risks, complications & prognosis, in a language. I understand, by

Dr..................................................... I take full responsibility to have my............................................


(The treating Physician)

Leave against Medical Advice, entirely at my own risk.

I further undertake NOT to hold Arsh Hospitals or any of it’s' staff responsible for any adverse

outcome whatsoever.

Date / Time of Admission........................................

Date / Time of LAMA...............................................

Doctor's Signature:

Doctor's Name...........................................................

Signature:

Name: ..................................................................

Relationship with Patient..................................

Witness Signature:

Witness Name: ...........................................................

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