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Rina Evans
12-26-2013, 11:09 PM
I've tried to google this in every possible way for hours and hours. Who can sign discharge papers for an adult, mentally-competent, conscious person? If said person is not physically able to do so by herself. She has broken both her arms or wrists, or her dominant hand. Could she somehow put an 'X' herself, or have a friend sign for her, or could she simply leave? (In the USA, btw)

I wish there existed a long-running thread for simple questions that one or two people can answer.

thothguard51
12-26-2013, 11:23 PM
I have signed papers that my son has legal authority to act in my place if I am physically unable to do so in emergency situations.

That being said, I just spent 5 days in the hospital last month due to Congestive Heart Failure and COPD. While my son acted to admit me, I was able to sign my self out when the time came.

Rina Evans
12-26-2013, 11:28 PM
I have signed papers that my son has legal authority to act in my place if I am physically unable to do so in emergency situations.

That being said, I just spent 5 days in the hospital last month due to Congestive Heart Failure and COPD. While my son acted to admit me, I was able to sign my self out when the time came.

Hmmm, no, that won't help in this situation. She doesn't have family to act as decision-makers. She has some friends, though. She's of sound mind and completely awake, she simply can't physically put her signature on the paper.

Oldbrasscat
12-27-2013, 12:00 AM
She can still sign, unless the fingers of her hand are broken. It wouldn't be comfortable, but even a cast for a broken wrist will leave some mobility in the fingers. At worst, she could make an X and some adult at the hospital could sign as witness. It's really going to depend on policies at the hospital and whether there's any state regulation involved.

slhuang
12-27-2013, 03:06 AM
I was just in the hospital a few months ago and they didn't make me sign anything to leave. They just discharged me. :Shrug: (i.e., they told me I could leave and gave me some paperwork but nothing I had to sign, and helped me out of the hospital and into the care of my family since I couldn't move very well yet)

I wasn't leaving AMA, though. If your character is doing that it might be a different story (I'd guess because liability, etc.).

Beachgirl
12-27-2013, 04:44 AM
Some hospitals only require the patient to sign something at discharge if the patient is leaving against doctor's recommendations. I did this once and had to sign a form stating that I would not hold the hospital responsible.

My son was in the hospital a few weeks ago and there were no papers to sign at discharge. They just gave us some papers with recommended after-care information and a script to take to the pharmacy and we were on our way.

MDSchafer
12-27-2013, 08:23 AM
With the advances in electronic medical records I think you could probably video a statement and append it to their file. We're not really there yet, but it would be better than the alternatives.

Motley
12-27-2013, 08:33 AM
I was just in the hospital a few months ago and they didn't make me sign anything to leave. They just discharged me.

Both times I was in giving birth and the 5-day surgery stay were like this. I didn't have to sign anything to leave the hospital. Like the others said, they just handed me paperwork, my prescriptions post surgery and wished me well.

WeaselFire
12-27-2013, 06:43 PM
I've tried to google this in every possible way for hours and hours. Who can sign discharge papers for an adult, mentally-competent, conscious person? If said person is not physically able to do so by herself.
The nurse, any discharge attendant, any relative. If they consent verbally, written or in smoke signals, it's still consent. I've signed for my mom, my wife has signed for me and the nurse initialed for a friend of ours who broke both wrists skiing.

We were helpful to him as well -- duct taped a pencil to his right middle finger so he could dial the phone. :)

Jeff

sheadakota
12-27-2013, 07:31 PM
Nurse here. Patients do not have to sign anything to be discharged unless they are being discharged AMA. Against medical advice, and most of the time they refuse to sign them.

Rina Evans
12-27-2013, 08:22 PM
Alrighty, thank you, everyone! I'll just make it so she doesn't have to sign anything. I was going to at first, but then it seemed like people might wonder how they let her out without signing stuff. Now I know it doesn't have to happen.

ebbrown
12-27-2013, 08:53 PM
I've tried to google this in every possible way for hours and hours. Who can sign discharge papers for an adult, mentally-competent, conscious person? If said person is not physically able to do so by herself. She has broken both her arms or wrists, or her dominant hand. Could she somehow put an 'X' herself, or have a friend sign for her, or could she simply leave? (In the USA, btw)

I wish there existed a long-running thread for simple questions that one or two people can answer.

A competent adult signs his/her own papers. If the patient has a busted hand, and "X" will suffice. If the patient is alone and can not sign for a physical reason, I sign for the patient and mark it as "unable to sign." I would allow a friend or relative at the bedside sign the paper with the verbal okay of the patient, and I would note it as such.

Discharge instructions and Consent for Treatment are 2 different things. If you're bleeding out from a GSW, we assume Consent for Treatment is given. We will save your life, even if you later say you're not paying for it or we can screw off.

Discharge instructions? Well, if a patient refuses to sign them, we just make a note that the patient was "non-compliant" and refused to let us give them instructions. Discharge instructions have nothing to do with the hospital getting paid, so all those yahoos who throw them at me? Well, have at it. Still gonna get billed, and it's not anything I have any control over.

When a patient truly is unable to sign, I make sure they understanding everything on the instructions. I make sure the person with them understands as well. Sometimes I write a smiley face in the signature spot, and we call it a day. Having the discharge instructions signed is truly more important to the hospital staff. When John Doe comes back to the ER a week later with a purulent wound 'cause he took 2 days of antibiotics and saved the rest for the next time, we can say, "Well, Mr.Doe, you were given teaching on how to take antibiotics, and you signed that you understood (or Mommy signed for you). Once again, listen carefully...and sign here."

As for simply leaving, patients do that all the time. Patients often complain about waiting for discharge paperwork. They don't understand that the paperwork is about 15 pages long, and a second nurse and I have to initial every page and co-sign that we are giving the correct paperwork to the right patient. It's not as easy as just handing over a piece of paper. I wish it was. So patients leave all the time without their discharge instructions. If they ask me if they can leave, I usually inform them they are a grown adult and if they do not wish to wait for instructions, then they certainly can make the decision to leave. We're not running after you if you leave without your instructions.

HTH. God, I love being an ER nurse.

StephanieFox
12-27-2013, 09:32 PM
A couple of years ago I was in the hospital overnight for emergency surgery. The next day, I felt fine and ready to go home, but they couldn't find the doctor to sign me out. I waited about six hours, proving to the nurses that I was fine (I did a dance in front of the nurse's station) and threatened to leave without the doctor's OK. They told me (and I don't know if this is true) that if I simply left, my insurance wouldn't cover my surgery. I was such a pest that they got another doctor to sign me out (he never saw me.) There are strict rules about leaving in a wheelchair, but I was afraid that would take me an extra hour or so and they let me walk out on my own two feet. I never had to sign anything to get sprung. If I didn't, I suspect more compliant patients wouldn't have to do so either.

(Sorry ebbrown, that I was so difficlut, but I did thank all the nurses, was polite and friendly and even thanked them for saving my life.)