Although representatives of the Allegheny Health Network Bloodless Medicine Service are on call, there may not always be a representative available in the hospital.
In order to assist our patients who wish to decline blood products in their care, the Allegheny Health Network now provides an online Advance Directive/Blood Transfusion Refusal form. You may also download a PDF version of the form. This document can be completed prior to a planned admission, or in the case of an emergency, even after you are admitted to the hospital. It can be accessed and completed on your personal computer, your tablet, or even your phone. (Tap the (i) Information bubbles on the form to see a brief explanation of each of the available choices.)
Once completed and submitted, a copy will be sent to the email address you entered, and to the Bloodless Medicine Service at Allegheny Health Network.
If you are completing this form prior to admission, please print a copy and bring it with you to the hospital. It's also a good to print copies and provide them to your primary care physician.
Allegheny Health Network recommends that you update and re-submit this document at least once a year.
In an Emergency:
For a Planned Admission/Procedure: