ADMISSION, TRANSFER AND

DISCHARGE PROCESS, VISTATION

AND EDUCATION, LAMA, DAMA,
MEDICO-LEGAL CASES

1
Content

2
 Introduction
People Enters a health care facility for:
• Assessment
• Diagnosis
• & Treatment of their disease condition .
• People approach healthcare agency for
availing medical, nursing & allied healthcare
services .

3
 OPD REGISTRATION PROCESS
• OPD registration shall be done first-come first-served basis.
Details required during OP Registration are :
– Name
– Age
– Sex
– Occupation
– Annual Income
– Address
– Phone (mobile/landline)
• The referral slip, if present should be checked to identify the
specialty. If there is no referral slip, the patient shall be
registered as specified by herself/ himself
• The details are entered into the OPD slip and the bill is raised.
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 OPD REGISTRATION PROCESS
• The patient is directed towards
Registration clerk of the concerned
OPD consultation area.

Consultation with doctor

Emergency admission during 24 hours

are taken

MLC registration if patient is

unidentified

Follow up / revisits shall be re

registered with same UHID
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 ADMISSION OF PATIENTS TO THE HOSPITAL.

• ADMISSION: it is the entry and acceptance of a

patient to stay in a health facility for the purpose
of observation , investigation and treatment .
Clients coming in for admission may walk-in
(ambulant ) or not.
TYPES OF ADMISSIONS
1. ELECTIVE/ PLANNED/ROUTINE
2. EMERGENCY
 Elective /Planned Admission
• The medical officer or the health
care provider arranges with the
patient on a convenient date for
admission.
• Patient is informed well ahead of
time to enable him prepare for the
admission.
• Patient is taken through the
admission process from the OPD.
ADMISSION OF PATIENTS TO THE HOSPITAL

Emergency Admission- with this

type of admission patient
reports to the hospital in a
critical condition; he/her is
usually brought in by people
(relatives, friends or a good
Samaritan).

The patient is transported to the

ward in a wheel chair or
stretcher. This type of patients
needs immediate treatment.
 REASONS FOR ADMISSION

• For diagnostic investigations to be done

• For treatments which may be medical or

surgical

• For observation
 ADMISSION PROCEDURE (PLANNED/AMBULANT PATIENT)

1. Welcomed Patient/ relatives to the ward/unit and

introduce yourself and any other nurse present to
the patients

2. Collect the necessary documents i.e. admission

papers and other information from the
accompanying nurse
 ADMISSION OF PATIENTS CONT’d
1. Identify and confirm patient by name particulars
2. Provided seats for patient and the relatives to
make them comfortable
3. Gather information from patient and if necessary
the relatives to fill the admission papers.
4. Depending on the condition provide an admission
bed.
5. Assist patient to change into pyjamas or hospital
gown and give identification bracelets if applicable
 ADMISSION OF PATIENTS CONT’d
6. Provide privacy and do baseline assessment of
patient and document (observation, vitals etc.),
collect specimen if ordered.

7. Serve prescribed urgent medication if applicable.

8. Ask patient and relatives to return patient valuables

back to home .

9. Ensure patient/ family sign consent form for

treatment.
 IN PATIENT ADMISSION PROCESS

The decision regarding admission Treating Doctor

Admission slip/order shall be made by the consultant
and an admission slip or order issued by her/him.
General consent for admission and treatment is
obtained from the patient and the patient's relative.
The order for admission shall be Treating Doctor
Admission note written in the OPD book/ ED Book
with the ward name, date, time, name and signature
of the consultant.
The patient or patient's relative shall be directed to
the admission counter to complete all the admission
formalities. 14
 IN PATEINT ADMISSION PROCESS
At the admission counter the consultant's note is
checked for admission.
IPD number and demographic details of the patient
are put into the admission register/computer to
generate an admission file (case sheet). This is
handed over to the patient and the admission fee is
collected.
The patient is directed to the concerned ward,
where the bed will be allotted

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 ADMISSION POLICY
ADMISSION OF A PATEINT INTO WARD:
Policy: Nursing staff to check the details of the patient
and the duly filled consent form before receiving the
patient into ward.

Procedure:
 Nursing staff of the concerned ward/ unit receives
the information about the admission of patient by
the billing executive.
 Informs the housekeeping staff for room and bed
preparation.
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 ADMISSION POLICY
 Patient is received in the ward by the nursing staff
assigned for that patient.
 Nursing staff greets the patient, introduces herself/
himself to the patient.
 The admission papers along with the general
consent will be checked by the nursing staff
 Patient is admitted in the ward.
 Patient will be given the hospital dress.
 Patient medical record is prepared with all the
necessary information like name, IP number, ward
and Bed number, name of the patient consultant in
each record. 17
ADMISSION PROCEDURE (EMERGENCY; PATIENT IN A WHEEL CHAIR or
stretcher)

Advance Preparing
Wash hands and assemble the following depending on
the condition
• Temperature tray
• Resuscitation/emergency tray
• Oxygen apparatus
• Patient is received into an already prepared bed-
type of bed may depend on the condition of the
patient i.e cardiac bed for for respiratory distress
 ADMISSION OF PATIENTS CONT’d

• Tray for venipuncture

• Suction apparatus
• Blood pressure apparatus
• Bed to suit patient’s condition.
 ADMISSION PROCEDURE…

1. Welcome patient/ relatives to the ward/unit and

introduce your self and any other nurse present
to the patients

2. Collect the necessary documents i.e. admission

papers and other information from the
accompanying nurse

3. Identify and confirm patient by name ,

particulars
 ADMISSION PROCEDURE…

4. Quickly assess the patient’s general condition

5. Receive patient into an already prepared bed –

depending on the condition.
6. Patient is changed into bed clothing if possible
 ADMISSION PROCEDURE...
7. Privacy provided and patient is assessed i.e.
checking of vital signs, observation and
examination- general appearance, skin for
abnormalities, pain, breathing pattern,
complaints, general reaction of the patient,
level of consciousness, etc.

8. Relevant history is taken from patient or

relatives
 ADMISSION PROCEDURE...
9. Ensure consent form is signed.

[Link] valuables are taken care of if necessary

[Link] health insurance scheme is explained to

the patient and relatives.

12. Patients relatives are informed about the visiting

hours, thing the patient needed on admission.
Patient is allowed see relatives and bid them
goodbye.
 Admission Process…
[Link] on the condition specimen collected and
tested.

[Link] patient using the nursing process.

[Link] prescribed medications

[Link]’s name and particulars are entered into

the admission and discharge book as well as the
ward state. Admission is documented in the
nurses note
 Admission process...
The Role of the Nurse in the Admission Process
• meeting the immediate needs of the patient-
physical and emotional
• Thorough assessment of the patient- nursing
process
• Ensure patient is assigned to the appropriate room.
• Write admission report- day and night report
• Ensuring comfort and reducing anxiety of patients
and relatives
 TRANSFER OF PATIENTS

Transfer of patient within a healthcare facility/hospital

It is the movement of a patient within the same health
facility
Types
• Transfer in/Trans –in: when patient is moved from one
unit or ward of first admission to a new unit or ward.
E.g. Medical to Surgical Ward, Emergency Ward to the
Medical or Surgical Ward for update treatment. The
receiving ward must be informed about trans in before
it is done.
 ROLES…
Steps
• prepare a suitable bed to receive patient
• Assemble the necessary equipment
depending on the patients condition i.e.
oxygen apparatus, suction machine, vital signs
tray.
• Receive incoming patient, relatives and
accompanying nurse warmly.
ROLES…
 TRANS IN (CONT…)

• Take over the transfer notes and personal belonging

of the patient from accompanying nurse.
• confirm patient’s identity with accompanying nurse
• Ask for clarification on vital issues pertaining to the
patient’s condition from the accompanying nurse.
• Introduce self and other nurses around to patient
and relatives
 TRANS IN (CONT…)
• Do a quick assessment of the patient’s condition
and needs and act accordingly
• Admit patient using the nursing process
• Orientate patient and relatives to ward and its
environment, routine of the unit if necessary
• Document time of patient’s arrival in the nurses
note, admission and discharge book and ward state.
TRANSFER OF PATIENTS
Transfer out/ trans out(CONT…)
Transfer out/ trans out: it could be from unit
to unit or facility to facility
Steps
• Confirm with receiving unit
• Assess patients condition
• Arrange for accompanying nurse
• Arrange for appropriate vehicle- where
applicable.
 Transfer out/ trans out(CONT…)
• Collect all necessary data
• Explain reason of transfer to patient and relatives
and reassure them to reduce anxiety
• Obtain written consent for transfer
• Pack patients belonging
• Collect patients medications , investigations results
and transfer notes
• Assist patient to dress up
• Assist patient into wheel chair, stretcher, ambulance
where applicable
Transfer out/ trans out(CONT…)

• Hand over patient’s notes and belongings

to the accompanying nurse.
• Enter patient’s name in the A&D book,
ward state and nurse note.
 DISCHARGE OF A PATIENT FROM THE HOSPITAL

Discharge occurs when a patient leaves the

hospital after a period of treatment to his or her
home; it normally done at the discretion of the
medical team when patient is fit or his condition
is stable or upon patient's own request.

It is important that patients and relative have a

prior knowledge of the intended discharge.
 DISCHARGE PLANNING

• It is a process that facilitate the transition of the

client from the health care institution to the most
independent level of care, home or another health
facility.

• The over all goal of discharge planning is to

provide the most appropriate level and quality of
care throughout all stages of the client illness. To
ensure adequate continuity of care.
 DISCHARGE OF A PATIENT FROM THE HOSPITAL

The role of the nurse in discharge planning

• Include all caregivers involved in the care of the patient
i.e. physiotherapist ( multidisciplinary)
• Adequate assessment of patient during all the stages
of care to identify discharge needs.
• Assess health teaching needs of client and family and
provide family members with the knowledge and skills
to care for the client in the home setting e.g. wound
care, range of motion exercises.
• Assess home situation i.e. bathroom facilities,
doorway, steps , home arrangement etc.
 DISCHARGE PROCESS

STEPS
• Ensure discharge is ordered by a medical
officer or signed letter from patient
• Patient and relatives are informed about
discharge
• They are educated on the need for
continuing treatment and follow up care

DISCHARGE OF A PATIENT FROM THE HOSPITAL...

 DISCHARGE…

• Ensure patient’s hospital bills are worked out and

submitted to the health insurance officer or paid at
the revenue office by patients who are not members
of the scheme.
• Receipt number is entered into the A&D book and
the receipt handed over to the patient.
• Relatives are directed to collect prescribed drugs
from the pharmacy if applicable.
 DISCHARGE…

• Drug administration is well explained to patient

and relatives as well as education on home and
follow up care
• Patient is helped to pack belongings.
• Any patient valuable in the nurses custody is
handed over to patient and relatives, it is recorded,
witnessed and signed.
 DISCHARGE…
• Patient and relatives are once again reminded of the
review date and exactly where to report on the said
date.

• Bed linen is removed, bed and lockers are

decontaminated.

• Discharge is documented in the nurses note,

Admission & Discharge book and ward notice board.
VISIT AND CROWD CONTROL

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 DEFINITIONS

• “Crowd Management” is defined as techniques used

to manage lawful public assemblies before, during
and after the event for the purpose of maintaining
their lawful status.

• This can be accomplished in part through

coordination with event planners and group leaders,
permit monitoring, and past event critiques and
visitation policies.

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 CROWD MANAGEMENT, INTERVENTION, AND
CONTROL STRATEGIES
Crowd management, intervention, and control strategies
and tactical considerations may include (not in priority
order):
• Establishing contact with the crowd
• Gaining verbal compliance
• Supporting and facilitating First Amendment activities
• Developing a traffic management and/or control plan
• Using crowd control and dispersal methods
• Protecting critical facilities
• Providing a high-visibility law enforcement presence

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 DISPERSAL ORDERS
Methods that may be used to deliver and document dispersal orders
includes
• Loud speech
• Amplified sound
• Display of signage indicating unlawful assembly and dispersal
• Gaining the attention of the crowd and documenting affirmative
responses of crowd members prior to the declaration of unlawful
assembly
• Positioning law enforcement personnel to the rear of a crowd to
confirm and document hearing the transmission of the dispersal
order
• Acquiring multiple-language capability
• Using video/audio recording equipment for documentation of the
dispersal order 45
 HOSPITAL PATIENT VISITOR POLICY

PURPOSE
Visitors are important for the patient’s well being and
assist in their recovery.
The purpose of the Visitor Policy is to provide guidance to:
A. Reduce disease transmission by avoiding crowded
situations and by asking ill visitors not to visit.
B. Provide restful, non‐disruptive nursing care.
C. Promote family/ patient‐centered care.
D. Control appropriate access to hospitals.

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 GENERAL VISITATION PRACTICES
• Visiting times are usually fixed b/w 8:00 AM – 8 PM
but may vary on specialized units.
• If patients desire visitors at other times, arrangements
can be made with the Charge Nurse.
• The patient or their support person will be made
aware of any specific circumstance limiting visiting.
• Visitor timings to be mentioned outside the unit and
visitor pass should be issued to the family members .
• Every time when visitors arrive the pass holder must
be present at security.

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 VISIT POLICY
• All visitors to pass identification and badging
procedures, ensuring that only those visitors who
should be on the premises are granted access.

• Security staff also should maintain a list of patient

visitor requests and other information in order to
reinforce restraining orders or facilitate the visits of
separated parents allowing them to be with their
child during different shifts.

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 Visitors policy

• Visiting Time
• 2 visitors at a time .
• Visitor limitations in Maternal
Child Health are based on unit and
patient criteria.
• Children (age 12 and under) may
visit the inpatient units but not the
intensive care units
• Children must be accompanied by
an adult and must be directly
supervised at all times.
• The patient cannot be considered
the designee supervising the child.

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 Visitors Policy
• Visitors with respiratory / communicable
disease are prevented from visiting
patient.
• Those patient’s with visitor restriction
should be informed and “ visitors restricted
board should be displayed outside .
• If restriction for flowers and pets it should
be displayed outside
• For visitors who has to place face mask
should be instructed and face mask should
be kept outside patient room.
• Place hand rub outside patient room so
that visitors can perform handwashing
before and after patient visit.

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 VISITATION PRACTICES
• The Visitor Practices will be posted at hospital
entrances in both English and local language
• A Guidance for Visitors brochure will be given to all
visitors explaining visitor practices, parking,
refreshments, the smoke free environment, and the
importance of hand hygiene and cough/sneeze
etiquette.
• Provision of Patient Rights and Responsibilities

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SATEMENT OF PATIENT VISITATION RIGHTS

• Visitor policy and practice should

be written and is displayed which
includes
• Patient visitation rights and
general visiting hours
• Patient right to receive the visitors
whom he or she designates,
including, but not limited to, a
spouse, a domestic partner
• Patient right to withdraw or deny
such consent at any time
• Justified Clinical Restrictions which
may be imposed on a patient’s
visitation rights.

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Sample Visitors Instructions board

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BE SPECIFIC ABOUT VISITING TIME

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MAKE SURE VISITORS HAVE PROPER
INSTRUCTIONS

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INSTRUCTIONS FOR VISITORS

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OTHER SIGNAGES FOR VISITORS

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SAFETY SIGNAGES

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SIGNAGES FOR VISITORS

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 VISITATION RESTRICTIONS
• There are certain circumstances for health and safety reasons
that visitation may not be allowed, which include .

1. Patient requests for no visitors or not to have certain visitors.

2. Infection Control issues.

3. Patient is undergoing care interventions.

4. Visitors may be interfering with other patient’s care.

[Link] healthcare team has determined the presence of particular visitor may
harm , patient/staff/operational activity of hospital

6. The patient is in custody of law enforcement

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 CLINICAL RESTRICTIONS
Failure of visitor to follow organization infection control guidelines.
1) Disruptive behavior by visitor.
2) Unsafe practices exhibited by visitor (ie: smoking in patient
room/cubicle).
3) Evidence of visitor communicable disease.
4) Organization need to take extraordinary protections because of a
pandemic or infectious disease outbreak.
5) Need for privacy or rest by another individual in the patient’s
shared room. Clinical Policy and Procedure – Visitor Policy
6) When patient is undergoing a clinical intervention or procedure
and the treating health care professional believes it is in the patient’s
best interest to limit visitation during the clinical intervention or
procedure.
7) A court order limiting or restraining contact with the patient. 61
CAUTION FOR VISITORS

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 VISITOR RESPONSIBILITIES
[Link] ensure cleanliness and for your protection, bathrooms in
patient rooms are for patient use only.
[Link] is a priority at Strong.
[Link] ongoing effort to promote a restful, healing environment the
following items are prohibited: alcoholic beverages, disruptive or
violent behavior, smoking, street drugs and weapons.
[Link] should be asked to help in controlling noise by:
speaking softly placing cell phone setting on vibrate and
minimizing the number of visitors within your loved one’s room
at one time.
[Link] be respectful of the property of other persons and of the
hospital.

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LEFT AGAINST MEDICAL ADVICE (LAMA)

• LAMA has been defined in the broadest terms

as any patient who insists upon leaving against
the expressed advice of the treating team. 
Occurs both in :
– IP & ED
– Rural and Urban hospitals
– Developed and developing countries .

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 What are the contributing factors for LAMA?

Alcohol
Drug abuse
Psychiatric admissions
Medical admissions
Socio –economic conditions
Dissatisfaction with the current healthcare provider-
physician behaviour , staffing , policies , facilities ,
length of stay etc..

65
LAMA- POLICY
t in h os pital
t s m a y be kep major
o P atie n xce pt in
N
in s t t h e ir will e ication, police
aga ss, intox
tr ic i ll n e
psychia custody

Healthcare team must persuade patient

to stay back and at the same time try to
identify the reason for leaving. If possible
problem should be addressed.

Treating doctor should explain to patient and

relative about the consequences of leaving .
If pt leaves hospital ceases should be
responsible for his /her care.

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LAMA - POLICY
If patient still wishes to leave
take patient or authorized
attendant signs a form to this
effect before leaving the hospital.

In the event that the patient

refuses to sign the form, this
should be documented clearly
in the Medical Records.

All discussions and risks

explained should be recorded in
the patient's Medical Records.

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 DISCHARGE- Definition
• “Discharge of patient from the hospital
means, reliving a person from hospital setting,
who admitted as an inpatient in that hospital”

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 TYPES OF DISCHARGE

• 1. Planned discharge:-patient completes the

initial, actual management in the hospital and
now he or she need not to be under direct
supervision of that hospital.’
• 2. DAMA :– Discharge against medical advice .

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 STEPS OF PLANNED DISCHARGE

• 1. Written order by doctor.

• 2. Discharge card.
• 3. Informing other departments.
• 4. Check payment of the bills.
• 5. Hospital glossaries taken back.
• 6. Returning of the personalbelongings.
• 7. Arrangement for transport.
• 8. Documentation
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 DAMA steps
• Patient leaves the medical facility against doctors advise
• “IAM LEAVING THE HOSPITAL WARD AGAINSTMEDICAL ADVICE.
DOCTOR EXPLAINED ME ABOUTMY DISEASE CONDITION AND ILL
EFFECTS OFDISCHARGE AGAINST MEDICAL [Link],
HOSPITAL AND STAFFS WILL NOT BERESPONSIBLE FOR ANY ILL
EFFECTS HAPPENINGAFTER MY DEPARTURE”.
• Name of the patient / relative :-
• Relation:-
• Signature:-
• Date :-
• Time:-

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DISCHARGE PROCESS

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 Discharge summary
After the final decision to discharge the patient is taken,
the treating Consultant prepares the discharge
summary of the patient which contains the following
information:
i. Reasons for admission
ii. Investigations performed and summarized
information about the results of the investigations
iii. Final diagnosis
iv. Record of any procedures (operations) performed
v. Condition of the patient at the time of discharge

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 Discharge summary
vi. Medication instructions
vii. Follow-up advice
viii. How to obtain emergency contact
ix. A standardized discharge summary for uniformity
x. Departments shall prepare discharge summary
forms based on the content specific to their
department
xi. In case of a death, the death summary shall also
contain the cause of death

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NURSE’S RESPONSIBILITY IN DISCHARGE PROCEDURE
& PREPARATION FOR DISCHARGE

• Planning in the beginning.

• Plan for rehabilitation and follow-up need.
• Teach nursing procedures to be continued at
home, get it’s practice done.
• Arrangement for transport.

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 DURING PROCEDURE
1. See doctor’s written order.
2. Inform other departments regarding the discharge .
2. Discharge summary should be prepared and Explained to patient
and relatives . Copy of discharge summary should be attached to
patient file.
3. Copy of investigation report to be handed over to patient and one
copy to be filed in patient file .
4. Hand over personal belongings.
5. Check and receive any hospital property.
6. Confirm bill paid.
8. Arrange transport.
9. DAMA :-check consent

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 Discharge procedure

AFTER DISCHARGE
• 1. Documentation.
• 2. Care of patient’s room and articles

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 Medico –legal case
• It can also be defined as a case of injury or
ailment, etc., in which investigations by the
law-enforcing agencies are essential to fix the
responsibility regarding the causation of the
said injury or ailment. Simply put, it is a
medical case with legal implications or a legal
case requiring medical expertise.

78
 MEDICO- LEGAL CASE
List of cases that should be considered as MLC (cases
may include and not be limited to):
i. ALL suspected accidental, suicidal and homicidal
cases that may include poisoning, road traffic
accidents, falls from a height, sharp-edged injuries,
near drowning, blunt injuries, fire & burn injuries
ii. Sexual assault /rape
iii. Brought-dead patients
iv. Any accidental or domestic injury to any female
within seven years of marriage.

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SOP FOR HANDLING MEDICO- LEGAL CASE
1. All complaints and events shall be recorded. Details which
are mandatory are :-
2. Place of incident
3. Date and time of incident
4. People involved in that event
5. Who brought the victim to hospital
6. Witnesses
7. Injuries and marks associated with the incident
8. Inform nearest police station about the incident
9. Name and details of police person who collected and filed
the FIR
10. Counselling of patient and relatives about the hospital
protocols and policies.
 SOP FOR HANDLING MEDICO- LEGAL CASE
 A written intimation shall be prepared and given to the
police when they come to the HCO or shall be sent across
noting the date and time of telephonic intimation
4. All MLCs after registration are to be issued for OPD /IPD
cases and should be marked register "MLC".
5. MLC number shall be stamped on all paper and patient
records.
6. Clinical notes shall be entered in IPD/OPD case paper
and in an MLC form book.
 Examine the patient for all injuries. Take a detailed history
of the event. Start the medical management as required.
Inform the concerned Consultant accordingly; proceed
further with the necessary investigations 81
SOP FOR HANDLING MEDICO- LEGAL CASE- filling up
injury sheet
 Injury sheet must be filled up and all columns completed.
 Place special emphases on
 Identification marks
 Who the patient was brought by
 The site of accident
 Name, age, sex
 Date, time of arrival
 Detailed examination of the injury.
 Record all injuries in an order starting from top to bottom.
Eg ; Injuries on the scalp are to be mentioned first and those on
toes to be mentioned last.

82
 SOP for handling MLC –Filling up injury form

Wound description-
 Type of injury
 Dimension
 Extension
 Site/location according to the nearest landmark,
opinion on wound whether fresh or old should be
recorded in detail.
Opinions on any investigation required for the
wound should be mentioned with each wound
description.
83
SOP FOR HANDLING MEDICO- LEGAL CASE- Poisoning
 All alleged poisoning cases shall be marked 'No External Trauma/Wound
Observed'.
 Rule out any external injury or abnormal mark on the body.
 In all poisoning cases, a gastric lavage sample (20-50ml) shall be taken and
clothes of the patient preserved, sealed and handed over to the police as
soon as possible.
 Till the police receive it, lavage samples should be stored at 4 to 8 degree
Celsius.
 No lavage sample should be attempted in any acid or kerosene oil
poisoning or burn case.

84
SOP ON MLC – Assault/ Trauma
In assault or trauma cases, the left thumb impression of the
patient along with two marks of identification is mandatory
to identify the patient whether conscious or unconscious.
Obtain the consent of the patient and a declaration that 'I
have shown all my injuries to the Doctor on Duty'.
This is mandatory in assault cases.
In all MLCs, medico-legal evidence like patient's
clothes with blood stains, stab injury, cut mark and
bullet hole marks shall be encircled, signed by the
examining doctor, and preserved.

85
 SOP FOR HANDLING MEDICO- LEGAL CASE
 Any foreign body recovered from the patient after an
operation, such as a bullet, shall be sealed and handed over to
the police under receipt.
 Clothes/weapon/gastric lavage samples of all MLCs should be
properly preserved, labeled and handed over to the medical
records department (MRD) to be handed over to the police
when demanded.
 Picture sketches in all MLCs such as burns, assault, trauma,
shall be marked properly and completely on the body
sketches on the reverse of the injury sheet.

86
 SOP FOR HANDLING MEDICO- LEGAL CASE- documentation and confidentiality

 Information and documents of MLC’S shall be released only to

concerned authority with proper letter/ police requisition.
 A separate register shall be maintained for each MLC with the
required data at emergency.
 A counter-signature from the police station shall be taken
from the representative in a patient's MLC form/book.
 The time of informing the police and time of arrival of the
police shall be entered in the MLC form.

87
 SOP FOR HANDLING MEDICO- LEGAL CASE
9. In case the police do not arrive within 24 hours of
the MLC report, a reminder shall be sent asking for
an acknowledgment.
10. If any patient refuses to be registered as an MLC,
the Medical Superintendent should be immediately
informed for a further line of procedural action.
11. All MLCs registered with the hospital shall be
intimated to the consultant on duty and the medical
superintendent.
12. In case of any doubt regarding registering MLC, the
medical superintendent shall be consulted.
88
 SOP FOR HANDLING MEDICO- LEGAL CASE
13. If any patient registered under MLC dies during
hospitalization, postmortem is a mandatory procedure and
the patient's body shall not be handed over to the patient's
relative but to the respective police station in order for the
postmortem to be conducted at the district hospital.
14. A case summary shall be provided to the police at the time of
handing over the dead body for submission to the district
hospital.
15. When MLCs are discharged, the relevant police station shall
be notified.

89
 SOP FOR HANDLING MEDICO- LEGAL CASE
16. All medico-legal discharge cases should be registered in the
same way at all stages, as recorded at the time of admission.
17. A copy of all the reports of the investigation shall be kept in
the MRD file before discharging the patient.
18. No MLC records shall be handed over to the patient and
relatives .
[Link] over legal documents to concerned police .
[Link] discharge, MRD files of all MLCs shall be stored
separately and be under the control of a designated person.

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 SOP FOR HANDLING MEDICO- LEGAL CASE
21. The responsible MO/Consultant shall arrange to prepare the
injury certificate with the help of the CMO & the medical record
department shall preserve a copy of the signed certificate in the
patient record.
22. At the time of handing over the certificate to police, the
designation and buckle number of the police representative shall
be noted in the second copy and the signature of the police
taken.
23. All MLCs shall be reported to the medical superintendent on
a monthly basis.
[Link] original injury certificate shall only be issued to the police
and not to the patient or relatives.

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 Roles and responsibilities of medical team in
MLC
• Every Doctor’s primary responsibility is to attend
the victim .
• Try all possible ways to resuscitate the patient.
• Ensure that patient is out of danger -All legal
formalities stand suspended till this is achieved.
• Identify the case as MLC / Non MLC.
• Document the assessment completely .
• MO shall Inform the police constable on duty with
required details of incident and victim.
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MLC NOTIFICATION FORMAT

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 Conclusion
• MLC’S has to be dealt properly and carefully by the hospital
team .
• Clear documentation is mandatory to save you from law suits .
• Dignity &Respect should be given to victims
• Privacy and confidentiality should be maintained.
• No information shall be concealed .
• As an emergency Nurse / doctor your primary responsibility is
to provide care and stabilize the patient .
• All events related to the MLC shall be documented till
discharge .

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 BIBLIOGRAPHY
 Accreditation Standards for Hospitals. NABH
Guidebook for pre-accreditation entry-level
standards for small healthcare organizations
(SHCOS). First ed. May 2015, 21-25, 33-35, 43-48.
Available at
[Link]
_entrylevelstandards_SHCO.pdf
.
 Specialty Treatment And Research expertise,
Nursing department manual. 2015, 18-19.

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