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Blood Transfusion Refusal

AHN will accommodate patients who opt out of receiving blood products during their care. Please complete the form below prior to a planned admission. It can also be completed after admission in the case of an emergency

For assistance with this form, please contact the AHN Office of Bloodless Medicine & Patient Blood Management at (412) 359-8787.

Refusal Form

I direct that no transfusions of:

  • Whole Blood
  • Red Cells
  • White Cells
  • Platelets
  • Plasma 

are to be given to me under any circumstances, even if physicians deem such necessary to preserve my life or health.