SAMPLE: Intake Form for law enforcement Blood Alcohol or Drug Screening:Mar 14, 2005 This sample form demonstrates the type of "probing questions" that CMS expects to occur to assure that a law enforcement test situation does not require EMTALA medical screening. While a form is not required, failure to document all elements may make it difficult to defend against an EMTALA violation or medical malpractice litigation. By Stephen A. Frew JD.

SAMPLE: Medical Screening Exam -- Mental Health:Mar 14, 2005 Sample form demonstrating typical elements that an Emergency Physician should document in their mental health screening exam after first completing the medical screening exam. By Stephen A. Frew JD.

SAMPLE: Transfer Form:Mar 14, 2005 Contains sample elements for documenting transfer information required by EMTALA. CMS does not mandate use of a specific form, but risk management requires a form to assure compliance. Some states require state approved forms. By Stephen A. Frew JD.

SAMPLE: Patient Requested Transfer form:Mar 14, 2005 Sample of elements to document when a patient initiates a request for transfer -- must be without any direct or indirect suggestion or pressure from the hospital for physician... By Stephen A. Frew JD.

SAMPLE: Refusal of services form:Mar 14, 2005 Form demonstrates elements necessary to document for the purposes of an "Informed Consent To Refuse" if a patient refuses any services or wishes to leave without completion of the MSE or other services.... By Stephen A. Frew JD.