Physical Restraint Consent
Updated to reflect current Requirements of Participation – this format provides for:
ŸInformation regarding restraints including potential risks and benefits
ŸDocumentation of less restrictive approaches used prior to the recommendation for use of restraint
ŸDocumentation of restraint type, frequency and duration of use as well as medical symptoms for which a restraint is indicated
ŸAcknowledgement/consent or declination clearly designated along with information on changing the decision
Size: 8 1/2" x 11"
Construction: 2-part feather-edge carbon interleaved snap set
Paper: white original and canary copy
Print: black ink, printed two sides different - part 2
Punching: 5-hole side punched
Packaging: 100 per pack
Construction: 2-part feather-edge carbon interleaved snap set
Paper: white original and canary copy
Print: black ink, printed two sides different - part 2
Punching: 5-hole side punched
Packaging: 100 per pack