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Release From Responsibility Form
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Release From Responsibility Form
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I acknowledge that I have declined to accept recommended treatment and/or transport for medical assessment, diagnosis and possible treatment by a physician and recognize the risk in doing so.
I, as a result of this form, release the City of Richmond, Richmond Fire-Rescue, the Emergency and Health Services Commission, its contractors and the consulting hospital from all responsibility for any ill effects which may occur from my action.
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