https://idonotconsentform.com/excerpt:
MY CAREFULLY PLANNED AND INTENTIONAL WISHES THAT ARE BASED UPON MY DEEPLY
HELD RELIGIOUS AND SPIRITUAL BELIEFS INCLUDE:
_____I DO NOT CONSENT TO THE USE OF MEDICATIONS WITHOUT MY BEING INFORMED
OF EACH MEDICATION’S RISKS, BENEFITS, AND ALTERNATIVES BEFORE THEY ARE
ORDERED. Only AFTER that information is communicated shall I choose to either grant consent or to not
grant consent for each medication that is ordered. This does not obviate the EXCEPTION for immediately
effective emergency resuscitation drugs or for elective or emergency requiring IV, local, or regional anesthetic
drugs to be given to allow a surgical procedure where consented anesthesia and/or surgery is required.
_____I DO NOT CONSENT to receiving ANY vaccine or booster for COVID19 or COVID19 variant.
_____I DO NOT CONSENT to receiving the seasonal Flu vaccine.
_____I DO NOT CONSENT to receiving the Pneumococcal vaccine.
_____I DO NOT CONSENT to receiving ANY vaccination for ANY purpose or disease.
_____I DO NOT CONSENT to the use of Remdesivir, or its brand name called Veklury, or ANY drug related
to Remdesivir or Veklury under ANY circuмstances.
_____I DO NOT CONSENT to a ventilator in the case of a COVID19 diagnosis, or COVID19 variant
diagnosis, or any virus diagnosis (such as, but not limited to, Bird Flu virus diagnosis, Nipah virus diagnosis,
Hantavirus diagnosis) WITHOUT consultation with myself regarding the risks, benefits, and alternatives
PRIOR to the implementation of the ventilator. Only AFTER that information is communicated to me shall I
choose to either grant consent or to not grant consent for the ventilator.
Topic: I do not consent form -- for ER or hospital (Read 689 times)