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Bloodless Medicine Patient Information 

In order to assist our patients who wish to decline blood products in their care, we offer an online Blood Transfusion Refusal Form that can be completed prior to a planned admission, or in the case of an emergency, after you are admitted to the hospital.

Planning an admission/procedure - a guide for bloodless medicine patients

To assist our patients who wish to decline blood products in their care, AHN now provides an online Advance Directive/Blood Transfusion Refusal form. You may also download a PDF version of the formIf 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.

Although representatives of the Allegheny Health Network (AHN) Bloodless Medicine Service are on call, there may not always be a representative available in the hospital.

This form:

  • Can be completed prior to a planned admission, or in the case of an emergency, even after you are admitted to the hospital.
  • 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.

For a Planned Admission/Procedure:

  1. Promptly discuss your wishes with your doctor or other healthcare provider. It is vital that you allow your doctor time to develop an appropriate care plan for you, or if necessary, refer you to another physician.
  2. Provide a copy of your completed, signed Advance Medical Directive to your physician/healthcare provider, and bring a copy with you to the hospital, even if you have provided a copy at an earlier admission.
  3. Provide a copy of your completed, signed Advance Medical Directive to your designated healthcare agent and inform them of your planned admission to the hospital so they can be available to speak for you if needed.
  4. You may call the AHN Bloodless Medicine Service at prior to your planned admission to schedule a brief consultation with a representative. This service is provided to patients free of charge.

In an Emergency:

Identify yourself as a “bloodless medicine” patient upon admission to the hospital, and ask that a consult be placed with the Bloodless Medicine Service.

Re-submitting this document

Allegheny Health Network recommends that you update and re-submit this document when any of the information you submitted changes.

Contact us

Call (412) 359-8787 to learn more about Bloodless Medicine at AHN.