AMA
I have reviewed the relevant issues with the patient. They are aware of the suspected diagnosis suggested by limited medical exam : ***

Capacity Assessment: Patient demonstrating all four key elements of capacity. The patient demonstrates understanding and appreciation of the relevant information of the nature of their medical condition, as well as the risks, benefits, and treatment alternatives (including non-treatment), consequences of refusing care, and can appropriately communicate a rational reasoning about their choice of care options.

Risks and Recommendations: The risks of refusing recommended care that were disclosed and acknowledged by the patient include loss of current lifestyle, permanent mental impairment, and death.
The recommended medical care being refused has been discussed with the patient and is to stay for continued monitoring, workup, and possible treatment.

Discharge Care: The patient understands they are welcome to return to the hospital at any time to receive the recommended care or any other care at any time, regardless of their ability to pay for such care.
Discharge instructions were provided to the patient.

---

Capacity
The patient is oriented [to person, place, and time], exhibits no alcohol or drug intoxication to a point that would impair ability to delineate a choice, and demonstrates all four key elements of capacity to make decisions regarding the medical care offered.
– Patient able to Communicate their treatment choice
– Patient able to Understand and recall information
– Patient able to Appreciate and process probable outcomes of their condition
– Patient able to Reason through communication their rationalization about their choice of care options, regardless of whether I as their provider agree with their rationale.

---

Malingering
Patient’s history and exam consistent with grossly exaggerated physical or psychological symptoms.
Patient has obvious incentives for secondary gain including shelter, attention, and obtaining drugs.
No specific acute medical concerns at this time. No e/o serious bacterial illness,

CURES database has been queried lately and shows multiple opiate prescriptions for this patient

Disposition: Discharge with instructions for appropriate signs and symptoms to be aware of and instructions on proper over the counter medication use for pain after discharge.