Patient Consent for Release

NON-PARAMEDIC TRANSPORT
NON-INJURY OR MINOR INJURY

I understand that a preliminary field evaluation has not revealed any condition sufficiently serious to require transportation to the hospital by EMTs/Paramedics. I agree with this assessment. I also understand that, while I still have the option of being transported to the hospital by EMTs/Paramedics, I prefer to make my own transportation arrangements for further evaluation. If my present condition worsens, I have been advised to seek prompt medical evaluation, which may include requesting EMTs/Paramedics respond again by dialing 911. This is to certify that I release the City of Escondido and its employees from any liability for any claim arising from, or associated with, my injuries or medical condition.

I acknowledge that I have read and understand the terms of this release, and I have signed it voluntarily. I agree that this release shall be binding on my relatives, heirs, legal representatives and assigns.