PFNHP Outpatient CFSS / ADO Form

As a patient advocate, in accordance with the Nurse Practices Act, this is to confirm that I/we notified you that in my/our professional judgment, my/our workload is unsafe and places my/our patients at risk. I have been mandated to provide care and do not want to abandon my patients. As a result, the facility is responsible for any errors or incidents that take place.
RN, LPN, MA...
RN, LPN, MA...