Final answer:
When a patient or SDM refuses to sign the Refusal of Service section of the ACR, healthcare providers should document the refusal and obtain a witness signature. Consulting with a medical supervisor is also advisable when there's doubt about patient's decision-making capacity.
Step-by-step explanation:
When a patient or their Substitute Decision Maker (SDM) refuses to sign the Refusal of Service section of the Ambulance Call Report (ACR), the appropriate course of action is to document the refusal and obtain a witness signature. It is critical to respect the patient's autonomy and right to refuse medical care, provided that they are legally capable of making such a decision.
If the patient has the capacity to make informed decisions and persists in refusing care or transport, document the conversation, their reasons for refusal any potential risks that were explained to them, and get a witness to sign in lieu of the patient's or SDM's signature. In cases where the patient's decision-making capacity is questionable, it is advisable to consult with a medical supervisor for further advice on how to proceed.