Refusal of Medical Treatment

By Elizabeth Franklin-Best, Esq., and Christopher Zoukis, JD, MBA

Form number	BP-A0358
Title as printed	MEDICAL TREATMENT REFUSAL (Rechazo de Tratamiento Médico)
Form-face date	JUN 10
Prescribed by	“Prescribed by P6031”
Replaces	“Replaces BP-S358.060 of MAY 94”
Governing Program Statement	6031.06, Patient Care — June 22, 2026
Governing regulation	None. PS 6031.06 cites no section of 28 C.F.R.
Languages on the form	English and Spanish, side by side on one page
Published by BOP?	Yes — BP_A0358.pdf
Distribution as printed	“Record Copy – Inmate’s Medical Record; Copy – Hospital File; Copy – To Inmate”
Privacy Act notice on the form?	No
False-statement warning on the form?	No

Checked against the BOP form set · 2026-09-07 · How we verify

BP-A0358 is a one-page form on which a person in federal custody records that they were offered a specific medical or dental treatment, were told what could happen if they declined it, and declined it anyway. Signing it does not end the Bureau’s obligation to keep offering care — the underlying rules are on our Patient Care (Program Statement 6031.06) and Dental Services pages, and the day-to-day picture is on Medical and dental care in federal prison.

Declining a recommended treatment is sometimes the wrong call and sometimes the right one. This page does not tell you which. It tells you what the document says, block by block, what the Bureau’s own policy tells staff to do with it, and what is conspicuously absent from it.

What this form is

BP-A0358 is a record of a conversation, generated by clinical staff and signed by the patient. It is not a request, not an appeal, and not a waiver of future care. The Bureau’s Patient Care policy treats it as documentation: proof that a clinician explained a recommended intervention and the risks of declining it, and that the patient declined.

It is bilingual on a single page — every English line is followed by its Spanish equivalent in parentheses, with no separate Spanish edition and no separate Spanish signature block. It is also a fillable PDF: typed labels extract cleanly from BOP’s published file, ruled boxes and the position of the signature lines do not. Every block below is named by the label BOP prints.

Two facts on the form face are worth reading first. The footer says “Prescribed by P6031” — the form belongs to the Bureau’s 6031 series, Patient Care, whose current edition is Program Statement 6031.06, dated June 22, 2026. And it says “Replaces BP-S358.060 of MAY 94.” The form has carried the stamp JUN 10 ever since — an old document that has outlived several editions of the policy prescribing it.

Block by block

Header — “BP-A0358 MEDICAL TREATMENT REFUSAL (Rechazo de Tratamiento Médico) CDFRM / JUN 10”

The form number, the bilingual title, the “CDFRM” mark BOP uses on its central-office form set, and the date stamp. Beneath it: “U.S. DEPARTMENT OF JUSTICE FEDERAL BUREAU OF PRISONS.” Nothing here is filled in.

“Date (Fecha)”

One date field — the date the refusal is recorded. It is not a deadline and not an expiry. Nothing on BP-A0358 starts a clock.

“I, ______, refuse treatment recommended by the Federal Bureau of Prisons Medical staff for the following condition(s):”

The opening sentence runs across the top, interrupted by a fill-in line labeled “Name and Registration Number (Numbre y Número de Registro)” — the eight-digit BOP identifier that ties this page to a specific medical record. Read the sentence closely: it refuses treatment for a stated condition, and the condition goes in the blank. A form completed with a broad or vague condition documents something quite different from one naming a single procedure.

“DESCRIBE IN LAYMAN’S TERMINOLOGY: (DESCRIBA EN TERMINOLOGIA COMUN Y CORRIENTE):”

An instruction to whoever fills in the condition: ordinary words, not clinical shorthand, so the patient can read what they are signing. If the entry on your copy is a string of abbreviations, the form was not completed the way its own instruction directs.

“The following treatment(s) was/were recommended: (El siguiente tratamiento(s) fue/fueron recomendado(s)):”

A second blank, naming the specific intervention — the medication, screening, referral or procedure. With the condition field above it, this defines the scope of what is being declined.

“Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment:”

The third and most consequential blank. The printed sentence asserts an explanation happened; the space beneath it is where the explained consequences are written down.

“Federal Bureau of Prisons Medical staff members have carefully explained to me that the following possible consequences and/or complications may result because of my refusal to accept treatment: (Los miembros del personal Médico del Bureau Federal de Prisiones me ha explicado cuidadosamente las posibles consecuencias o complicaciones siguientes que pueden resultar por causa de mi rechazo a aceptar tratamiento):”

Reproduced from BP-A0358, form face, English and Spanish as printed.

A blank consequences field on a signed form is a real gap: the sentence above it says the consequences were “carefully explained,” and the field beneath it is where that explanation is preserved.

The text above the signature line

This is what a person actually signs, and it is the operative text of the whole document:

“I understand the possible consequences and/or complications, listed above, and still refuse recommended treatment. I hereby assume all responsibility for my physical and/or mental condition, and release the Bureau of Prisons and its employees from any and all liability for respecting and following my expressed wishes and directions.

(Me doy por enterado de las posibles consecuencias o complicaciones enlistadas arriba, y aun así me rehuso al tratamiento recomendado. Por medio de la presente, asumo toda responsabilidad por mi condición física o mental, y relevo al Bureau de Prisiones y a sus empleados de cualquiera y toda responsabilidad por cause de respectar y seguir mis expresos deseos y direcciones.)”

Reproduced verbatim from BP-A0358, the sentence immediately above the patient signature block. Spelling and spacing are the agency’s.

Three plain readings of those words. It is anchored to the page: “the possible consequences and/or complications, listed above” points back to the consequences field, so where that field is blank the sentence refers to nothing. The release is limited by its own terms — liability “for respecting and following my expressed wishes and directions,” the act of honoring the refusal, not anything else the Bureau does or fails to do; whether such a release would be enforceable against a particular claim turns on the facts, the claim and the jurisdiction, and is a question for a lawyer. It does not surrender future care: nothing in it says the signer gives up treatment later, and Bureau policy says the opposite in terms.

Patient’s Signature and Date — then two witness lines

Three signature blocks follow, in this order:

1. “Patient’s Signature and Date (Firma del Paciente y Fecha)”
2. “Signature of Witness and Date (Firma del Testigo y Fecha)”
3. “Signature of Witness and Date (Firma del Testigo y Fecha)”

There are two witness lines, not one, and neither is a staff certification block. Nobody attests that the explanation was adequate, that the patient had capacity, or that an interpreter was used — the lines say “Signature of Witness” and nothing more. Why there are two becomes clear in the Program Statement: when a patient will not sign, two staff witnesses sign instead.

“Record Copy – Inmate’s Medical Record; Copy – Hospital File; Copy – To Inmate”

The distribution line. Three copies, and the patient gets one. If you signed a BP-A0358 and were not handed a copy, the form’s own instruction was not followed — and that copy is the cheapest way for a family member to learn what was actually written in the consequences field.

Footer — “Prescribed by P6031 Replaces BP-S358.060 of MAY 94”

The last line: the policy series that owns the form, and the form it superseded.

What the Program Statement tells staff to do

BP-A0358 is created and controlled by Program Statement 6031.06, Patient Care. Section 40(e), “Treatment Refusal,” is the operative instruction — and a Program Statement instructs staff rather than binding the Bureau the way a regulation does, so the verbs matter: this is what staff are told to do.

“When an inmate refuses recommended diagnostic testing, counseling, or treatment, clinicians document the refusal in the EHR, complete a BP-A0358, Medical Treatment Refusal form. At a minimum, refusals should be obtained any time the inmate refuses preventive health care (e.g., screening tests, labs, immunizations, etc.), CCC treatment plans, consultations for inhouse or community specialists, telehealth visits, or medication refusal. The refusal form is signed by the inmate and the witnessing staff and scanned into the EHR. If an inmate refuses care, and the clinician determines the clinical need continues to exist, the clinician should address the issue with the inmate at subsequent clinical encounters and document each discussion.

An inmate’s refusal of treatment will not preclude the inmate from reconsidering their decision and accepting care in the future. However, if the potential beneficial outcome of the proposed diagnostic testing or treatment has been compromised by the delay resulting from the inmate’s refusal, the inmate will be reevaluated to determine what treatment is clinically indicated.

If the inmate refuses to sign, two staff witnesses will sign the BP-A0358, Medical Treatment Refusal form, attesting to their observation that the clinician explained the consequences of refusing the proposed care in a language the inmate understood.”

Reproduced from Program Statement 6031.06, Patient Care at pp. 58–59. “EHR” is the electronic health record; “CCC” is chronic care clinic.

Four things answer questions people actually ask. Signing does not close the file. Delay can still cost something — where the benefit “has been compromised by the delay,” the patient is re-evaluated for what is clinically indicated then. The clinician is told to raise it again where the need persists. And two staff witnesses sign when a patient will not, attesting the explanation was given “in a language the inmate understood” — a requirement that lives in the Program Statement, not on the form.

The same policy sets the boundary: “As a general rule, medical and dental treatment, including medication, are only given when the inmate consents to treatment.” (PS 6031.06 at p. 58.) It lists four exceptions a Bureau physician may find — danger to life or of serious permanent injury; risk to others (its example is infectious tuberculosis); a court order; and a mental-health emergency as defined by the Bureau’s psychiatric policy. It separately treats tuberculin screening, chest x-rays and post-exposure blood specimens as potentially mandatory, refusal of which “will require an incident report,” routing that narrow category into the inmate discipline process. Twice it states that “[t]he inmate’s right to refuse medical treatment is not absolute and, in all cases, will be weighed against legitimate government interests, including the security and orderly operation of correctional institutions.” (PS 6031.06 at pp. 51, 59.)

What is not on this form

Four things that appear on many federal forms are absent here, and none should be assumed. There is no Privacy Act notice — no authority, purpose, routine uses, or consequences of not providing the information; compare the DOJ-361 Certification of Identity, which carries a full one. There is no false-statement warning: BP-A0358 cites 18 U.S.C. § 1001 nowhere. There is no OMB control number and no paperwork-burden statement. And there is no deadline anywhere on the page.

There is also no governing regulation. Program Statement 6031.06 cites no section of 28 C.F.R. at all. The nearest-sounding regulation, 28 C.F.R. § 549.65, “Refusal to accept treatment,” sits in 28 C.F.R. part 549, subpart E — “Hunger Strikes, Inmate” and addresses forced treatment where “as a result of inadequate intake or abnormal output, a physician determines that the inmate’s life or health will be threatened if treatment is not initiated immediately.” That is the hunger strike context. BP-A0358 is a creature of Program Statement alone.

What happens after it is signed

The form is scanned into the electronic health record; one paper copy goes to the medical record, one to the hospital file, one to the patient. Where the clinical need persists, the clinician is directed to keep raising it and to document each discussion.

A signed BP-A0358 is part of the medical file, reachable through the same routes as the rest of it — see Medical records access and, where someone else is requesting, the DOJ-361 Certification of Identity and BP-A0621 Authorization for Release of Medical Information pages. Refusal documentation surfaces most often in three places: a Bureau response to an administrative remedy about care that was not provided; the medical narrative supporting a compassionate release motion; and litigation over deliberate indifference. One practical consequence of the “document each discussion” instruction: where a clinical need persisted, the later encounter notes should show the subject being raised again. A single refusal form with nothing after it, on a condition that did not resolve, is itself something a reviewer will notice.

What to do if it is wrong

“I never refused that.” A refusal recorded for a treatment never offered, or for a broader category than what was declined, is a factual error in a medical record. Start with an Inmate Request to Staff — the cop-out — to the Health Services Administrator, naming the date and the entry. If that does not resolve it, the administrative remedy program runs BP-8 informal resolution, then BP-9 to the warden, BP-10 to the region, BP-11 to the Office of National Inmate Appeals. File early; the program has its own filing windows.

“Nobody explained anything.” The sentence above the signature asserts staff “carefully explained” the consequences, and the two-witness route asks witnesses to attest it was given “in a language the inmate understood.” Where that did not happen — no interpreter, no explanation, a blank consequences field — say so specifically, in writing, close in time. A contemporaneous cop-out is worth far more later than a recollection.

“They wrote it up because I wouldn’t sign.” That is what the two witness lines are for, and policy permits it. Worth checking is whether the document says only what the witnesses observed — a staff-completed form asserting the patient’s understanding asserts something they were not positioned to observe.

Applied Insight — Christopher Zoukis, JD, MBA, Managing Director: When we review a medical file, the BP-A0358s get read first and read closely — not for whether someone refused, but for what the condition, treatment and consequences fields actually say. A refusal narrowly recorded for one screening test is a very different document from one reading as a blanket refusal of care.

Legal representation is provided by Elizabeth Franklin-Best and the firm’s attorneys. See also Federal Bureau of Prisons policy and what families should know about federal prison.

Frequently Asked Questions About the Medical Treatment Refusal Form

Reviewed for legal accuracy by Elizabeth Franklin-Best, Esq., Principal Attorney·September 2026