PATIENT MEDICAL ADVICE, TREATMENT COMPLIANCE, STRICT PROHIBITION, INFORMED REFUSAL AND NON-COMPLIANCE POLICY. IMPORTANT LEGAL AND MEDICAL NOTICE
PLEASE READ THIS POLICY CAREFULLY BEFORE PROCEEDING WITH CONSULTATION, TREATMENT, INVESTIGATION, PROCEDURE, FOLLOW-UP OR ANY OTHER MEDICAL SERVICE.

This Policy forms an important part of the patient-information and medical-consultation process of [NAME OF DOCTOR / CLINIC / HOSPITAL].
Medical treatment is a collaborative process. The treating Registered Medical Practitioner (“RMP”) exercises professional judgment based upon the patient's clinical condition, medical history, examination, investigations and information made available by the patient.

The patient's cooperation, truthful disclosure and compliance with reasonable medical instructions are material to safe and effective treatment.
By proceeding with consultation, treatment, investigation, follow-up or any other medical service after being provided access to this Policy, the patient and/or the patient's parent, guardian or lawful attendant acknowledges and agrees to comply with the medical instructions applicable to the patient.

PART I
LEGAL AND PROFESSIONAL FRAMEWORK
1. APPLICABLE LEGAL PRINCIPLES
This Policy shall be read and interpreted consistently with the laws of India, applicable rules and regulations governing registered medical practitioners, applicable consumer law and the professional standards applicable to the treating doctor.
The National Medical Commission Registered Medical Practitioner (Professional Conduct) Regulations, 2023, as presently notified/listed by the National Medical Commission, emphasise the patient's best interests, respect for patient rights and opinions, clear communication, professional judgment and maintenance of appropriate patient records.
The professional conduct framework therefore recognises that medical treatment involves both:
(a) the professional duties of the treating doctor; and
(b) the patient's participation, disclosure, consent and cooperation.
Nothing in this Policy is intended to diminish the professional duties imposed upon the treating doctor by law.

2. STANDARD OF MEDICAL NEGLIGENCE
The patient acknowledges that the mere occurrence of an adverse medical outcome does not, by itself, establish medical negligence.
The Supreme Court of India in Jacob Mathew v. State of Punjab, (2005) 6 SCC 1, laid down important principles concerning the standard applicable to medical negligence and professional judgment.
The legal test is not whether a treatment resulted in the desired outcome, but whether the conduct of the medical professional fell below the standard reasonably expected of a competent medical practitioner in the circumstances.
The Supreme Court has subsequently continued to apply the principles in Jacob Mathew while considering allegations of medical negligence.
Accordingly:
ADVERSE OUTCOME ≠ AUTOMATIC MEDICAL NEGLIGENCE
Complication, deterioration, treatment failure, prolonged recovery or an unexpected outcome does not, by itself, establish negligence.
The facts and circumstances of the particular case, applicable professional standards, clinical condition, medical advice given, information available to the doctor and relevant conduct of the patient shall be considered in accordance with law.

3. INFORMED CONSENT AND PATIENT AUTONOMY
The patient retains rights recognised by applicable law, including the right to receive appropriate information and to make lawful decisions concerning medical treatment.
The Supreme Court in Samira Kohli v. Dr. Prabha Manchanda & Anr., (2008) 2 SCC 1, considered the principles governing informed consent in medical treatment.
The requirement of informed consent does not mean that a doctor must guarantee a particular outcome. It requires appropriate communication of material information necessary for a patient to make an informed decision.
Accordingly, where the patient refuses a recommended investigation, treatment, referral or procedure after being informed of the relevant consequences, such refusal may be documented.
The patient's autonomy shall be respected subject to applicable law and the circumstances of the particular medical situation.
PART II
PATIENT'S DUTY OF COOPERATION AND COMPLIANCE

4. MEDICAL ADVICE SHALL BE FOLLOWED
The patient acknowledges that medical advice is based upon the clinical information available to the treating doctor at the relevant time.
Medical advice may include:

• medication;

• dosage and duration;

• X-rays;

• laboratory investigations;

• scans or imaging;

• physical restrictions;

• posture-related restrictions;

• restrictions upon movement;

• restrictions upon exercise;

• dietary precautions;

• admission;

• observation;

• follow-up;

• specialist consultation;

• referral;

• transfer;

• surgery or procedure; and

• any other clinically appropriate instruction.

Where the treating doctor specifically instructs the patient to undertake or refrain from a particular act, movement, posture, activity or procedure, the patient shall strictly comply with that instruction.

5. MEDICATIONS
The patient shall take prescribed medicines strictly according to the dosage, frequency, route and duration advised by the treating doctor.
The patient shall NOT, without prior medical consultation:

• discontinue prescribed medication;

• increase or decrease dosage;

• alter frequency;

• substitute medication;

• commence additional medication;

• take medicines prescribed for another person;

• resume previously discontinued medicines; or

• undertake self-medication.

Any such conduct may interfere with treatment or adversely affect the patient's condition.

6. INVESTIGATIONS, X-RAYS AND DIAGNOSTIC PROCEDURES
Where the treating doctor advises an X-ray, laboratory investigation, scan, imaging study or other diagnostic procedure, the patient shall comply with the advice within the prescribed/reasonably required period.
The patient shall NOT deliberately:

• refuse a medically advised investigation;

• postpone an investigation without informing the treating doctor;

• interfere with the investigation;

• disregard preparation instructions;

• disregard positioning instructions;

• disregard movement restrictions applicable to the investigation; or

• independently determine that the investigation is unnecessary.

Where an X-ray or other investigation requires a particular posture, positioning, preparation or restriction, the patient shall follow the instructions of the treating doctor and/or diagnostic professional.
Any refusal or failure to undergo a recommended investigation may be documented in the patient's medical record.
PART III
STRICTLY PROHIBITED ACTS AND ACTIVITIES

7. STRICT PROHIBITION
Where any act, movement, posture or activity has been specifically prohibited by the treating doctor, the patient shall not undertake that act until the restriction has been expressly modified or withdrawn by the treating doctor.
The patient shall NOT, where medically prohibited:

1. fold or cross the legs;

2. sit with the legs folded/crossed;

3. sit on the floor;

4. squat;

5. kneel;

6. bend the affected body part;

7. twist or rotate the affected body part;

8. place unnecessary pressure upon the affected area;

9. put weight upon an affected limb/body part where prohibited;

10. undertake sudden movements;

11. lift heavy objects;

12. push or pull heavy objects;

13. run;

14. jump;

15. participate in sports;

16. undertake gym or strength-training activities;

17. perform exercises or stretches not authorised by the treating doctor;

18. independently resume physiotherapy or physical exercises;

19. manipulate or massage the affected area where prohibited;

20. deliberately test the affected area to determine whether it has healed; or

21. undertake any other activity expressly prohibited by the treating doctor.

THE PATIENT SHALL NOT ASSUME THAT AN ACT IS SAFE MERELY BECAUSE THE PATIENT FEELS BETTER.
Temporary reduction of pain or improvement of symptoms does not automatically amount to medical clearance.

8. NO SELF-TESTING OF RECOVERY
The patient is expressly prohibited from deliberately performing a restricted act merely to determine whether the condition has improved.
For example, where specifically prohibited by the treating doctor, the patient shall not:

• fold/cross the legs to “check” recovery;

• bend or twist the affected area to “test” it;

• lift weight to “test strength”;

• exercise to determine whether the condition has healed; or

• resume a restricted activity merely because pain has reduced.

The decision to modify or discontinue a medical restriction shall be made by the treating doctor or an appropriately qualified medical professional.

9. MEDICAL DEVICES, DRESSINGS AND SUPPORTS
Where applicable, the patient shall NOT, without medical permission:

• remove or alter dressings;

• remove or alter a splint;

• remove or alter a brace/support;

• interfere with a catheter or other medical device;

• manipulate an operated/injured area;

• apply unauthorised medicines or substances;

• apply home remedies contrary to medical advice; or

• undertake an independent procedure upon the affected area.
   

10. NO INDEPENDENT ALTERATION OF TREATMENT
The patient shall not alter treatment on the basis of:

• advice from friends or relatives;

• internet information;

• social media;

• previous prescriptions;

• another person's experience;

• advice from an unqualified person;

• temporary symptom relief; or

• personal assumptions concerning recovery.

If another medical opinion is obtained, the patient should disclose the same to the treating doctor and provide relevant prescriptions/reports wherever reasonably possible.

PART IV
FOLLOW-UP, REFERRAL AND REPORTING

11. FOLLOW-UP IS AN ESSENTIAL PART OF TREATMENT
The patient shall attend follow-up consultations on the date advised by the treating doctor.
Failure to attend follow-up may result in:

• delayed identification of complications;

• delayed modification of treatment;

• delayed diagnosis;

• inappropriate continuation of treatment; or

• deterioration of the patient's condition.

The patient shall not assume that follow-up is unnecessary merely because symptoms have improved.

12. REFERRAL / TRANSFER
Where the treating doctor determines that the patient requires:

• specialist consultation;

• advanced investigation;

• surgery;

• intensive care;

• ventilatory support;

• super-speciality treatment; or

• a facility beyond the available resources,

the patient and/or attendant shall comply with the advice for referral or transfer, subject to the patient's legal rights.
Refusal or unreasonable delay in complying with a medically advised referral or transfer may adversely affect the patient's condition.
Such refusal or delay may be documented in the medical records.

13. IMMEDIATE REPORTING OF DETERIORATION
The patient and/or attendant shall immediately seek medical assistance in case of significant deterioration or unusual symptoms, including:

• difficulty breathing;

• chest pain;

• persistent vomiting;

• convulsions;

• high fever;

• excessive bleeding;

• loss of consciousness;

• severe/increasing pain;

• sudden weakness;

• altered consciousness;

• sudden deterioration; or

• any other unusual or concerning symptom.

PART V
DISCLOSURE AND REFUSAL

14. COMPLETE AND TRUTHFUL DISCLOSURE
The patient shall provide accurate information regarding:

• previous illnesses;

• existing medical conditions;

• previous surgeries;

• allergies;

• current medication;

• previous adverse drug reactions;

• hospitalisation;

• investigations and reports;

• pregnancy status, where applicable;

• relevant habits/substance use;

• treatment by another doctor; and

• other information reasonably relevant to treatment.

Concealment or misrepresentation of material medical information may adversely affect diagnosis and treatment.

15. PATIENT'S RIGHT TO REFUSE
A competent patient may, subject to applicable law, refuse a proposed investigation, treatment, procedure, admission, referral or other medical intervention.
However, where such refusal occurs, the treating doctor may explain the reasonably foreseeable consequences of the refusal.
The refusal may be documented, including:

1. the advice provided;

2. the reasons for the advice;

3. material consequences explained;

4. the patient's decision; and

5. relevant circumstances.

This approach is consistent with the legal significance given to informed consent and patient autonomy in Samira Kohli.

16. REFUSAL AGAINST MEDICAL ADVICE
Where a patient expressly refuses recommended treatment, investigation, admission, observation, referral, transfer or follow-up after being informed of relevant consequences, the refusal may be recorded as Refusal Against Medical Advice / Informed Refusal, as appropriate to the circumstances.
The patient understands that such refusal may result in:

• deterioration;

• complications;

• delayed diagnosis;

• delayed treatment;

• prolonged recovery;

• reduced treatment options; or

• other adverse medical consequences.
   

PART VI
CONSEQUENCES OF NON-COMPLIANCE

17. ACTS CONSTITUTING NON-COMPLIANCE
The following may constitute material patient non-compliance where contrary to medical advice:
Medication

• discontinuing medicines;

• altering dosage;

• substituting medication;

• self-medication.

Investigations

• refusing advised X-rays;

• refusing investigations;

• delaying investigations;

• failing to follow investigation instructions.

Physical restrictions

• folding/crossing legs where prohibited;

• squatting/kneeling where prohibited;

• bending/twisting where prohibited;

• lifting weight where prohibited;

• exercising where prohibited;

• sports/running/jumping where prohibited.

Treatment

• removing supports/dressings;

• interfering with medical devices;

• applying unauthorised substances;

• independently modifying treatment.

Follow-up

• failing to attend follow-up;

• ignoring urgent review instructions;

• failing to report deterioration.

Referral

• refusing medically advised referral;

• delaying transfer;

• continuing treatment at an inappropriate facility despite medical advice for higher-level care.
   

18. CONSEQUENCES OF NON-COMPLIANCE
The patient acknowledges that failure to follow medical instructions may contribute to:

• worsening of the underlying condition;

• increased pain;

• delayed recovery;

• aggravation of an injury;

• complications;

• additional investigations;

• additional treatment;

• requirement for further intervention;

• prolonged treatment; or

• other adverse consequences.

Where such consequence is wholly or materially attributable to documented patient non-compliance, the same may be relevant to determination of causation and responsibility, subject to applicable law.

19. EFFECT OF DOCUMENTED NON-COMPLIANCE ON MEDICAL LIABILITY
Where the treating doctor has:

• exercised reasonable professional skill and care;

• provided appropriate medical advice;

• communicated relevant restrictions;

• advised appropriate investigations/referral;

• explained material consequences of refusal where applicable; and

• appropriately documented the advice and/or refusal,

and an adverse consequence is directly attributable, wholly or materially, to the patient's informed refusal, delay, concealment, deviation or non-compliance, the doctor shall not be held responsible to the extent that such consequence is legally attributable to the patient's conduct and not to independent negligence, professional misconduct or breach of duty by the doctor.

IMPORTANT:
THIS IS NOT AN ABSOLUTE EXCLUSION OF MEDICAL LIABILITY.
No provision of this Policy shall operate to exclude liability which cannot lawfully be excluded.

PART VII
MEDICAL OUTCOME AND PROFESSIONAL STANDARD

20. NO GUARANTEE OF PARTICULAR RESULT
The patient acknowledges that medical treatment does not constitute a guarantee of a particular result.
Treatment outcomes may vary because of:

• severity of illness;

• individual response;

• underlying conditions;

• complications;

• progression of disease; and

• other clinical circumstances.

The doctor remains responsible for complying with the applicable professional standard of care.

21. ADVERSE OUTCOME DOES NOT AUTOMATICALLY ESTABLISH NEGLIGENCE
The patient acknowledges that:
An adverse medical outcome, by itself, does not establish medical negligence.
The legal assessment of negligence depends upon the circumstances of the particular case and the applicable professional standard.
The principle recognised in Jacob Mathew v. State of Punjab remains relevant in assessing whether the conduct of a medical practitioner fell below the standard expected of a reasonably competent practitioner.
Accordingly, the occurrence of a complication, deterioration, treatment failure or undesirable outcome shall not by itself be treated as proof of negligence.

PART VIII
MEDICAL RECORDS AND DOCUMENTATION

22. DOCUMENTATION OF ADVICE AND NON-COMPLIANCE
The doctor/clinic/hospital may document:

• medical advice;

• treatment instructions;

• prescribed medicines;

• investigations;

• X-rays;

• physical restrictions;

• prohibited activities;

• warnings;

• follow-up advice;

• referral advice;

• patient's questions;

• patient's refusal;

• patient's non-compliance; and

• other clinically relevant information.

The NMC professional framework recognises the importance of appropriate patient records, and the applicable regulatory framework should be followed by the treating establishment.

23. PATIENT'S DUTY TO COMMUNICATE DIFFICULTIES
If the patient cannot comply with an instruction because of:

• financial difficulty;

• inability to obtain medicines;

• transportation;

• inability to attend follow-up;

• adverse effects;

• misunderstanding;

• physical limitations; or

• another genuine difficulty,

the patient should promptly communicate the same to the treating doctor.
The patient should not silently discontinue or modify treatment.

PART IX
LEGAL DISCLAIMER

24. NO WAIVER OF MANDATORY LEGAL RIGHTS
Nothing in this Policy shall:

1. exclude liability for negligence where negligence is established under applicable law;

2. exclude professional misconduct liability;

3. transfer the doctor's professional duties to the patient;

4. deprive the patient of any mandatory statutory protection;

5. prevent the patient from exercising a lawful right;

6. compel treatment contrary to applicable law; or

7. constitute an absolute waiver of legal remedies.

If any provision of this Policy conflicts with a mandatory provision of applicable law, the mandatory provision shall prevail.

25. CONSUMER LAW
Where medical services fall within the applicable scope of consumer-protection law, nothing in this Policy shall be interpreted as excluding the remedies or protections available under applicable law.
The Consumer Protection Act, 2019 provides the statutory framework for protection of consumer interests and consumer dispute redressal.
Accordingly, this Policy is intended to establish the patient's informed understanding of medical instructions and the consequences of voluntary non-compliance; it is not intended to contract out of mandatory consumer protections or lawful remedies.

PART X
ELECTRONIC ACCEPTANCE

27. FINAL DECLARATION
By selecting:
“I HAVE READ, UNDERSTOOD AND ACCEPTED THE ABOVE POLICY”
and proceeding with the medical service, the patient and/or parent/guardian/lawful attendant confirms:
 
I have read and understood this Patient Medical Advice, Treatment Compliance, Strict Prohibition, Informed Refusal and Non-Compliance Policy.
 
I understand that medical treatment requires my cooperation and that I am required to follow the medical instructions applicable to my condition.
 
I understand that I must not knowingly undertake any activity, posture, movement, medication change, investigation-related act or other conduct specifically prohibited by my treating doctor.
 
I understand that where I voluntarily refuse, delay, disregard or act contrary to specific medical advice, and an adverse consequence is attributable to such conduct, the same may be documented as patient non-compliance and may be relevant to determination of causation and responsibility, subject to applicable law.
 
I understand that medical treatment does not guarantee a particular outcome and that an adverse outcome, by itself, does not establish medical negligence.
 
I understand that nothing in this Policy removes any professional duty or liability of the treating doctor which cannot lawfully be excluded.
PATIENT / PARENT / GUARDIAN / LAWFUL ATTENDANT

Electronic Acceptance: ☒ YES
“I HAVE READ, UNDERSTOOD AND ACCEPTED THE ABOVE POLICY.”