LAMA form format for hospitals: LAMA, DAMA and absconding, with a free Hindi and Gujarati pack.

One pack, five parts:

1. LAMA / DAMA form: the patient, the condition, what treatment remains, the risks explained in your own words, alternatives offered, the reason, the language used, signatures and witness, and a before-leaving block (summary, medicines, warning signs, ambulance, bill, police, PM-JAY).
2. The declaration in Hindi and Gujarati, to read to the patient. These are our translations, marked as an aid: we found no official Hindi or Gujarati LAMA form.
3. Refused to sign, or absconded: what staff record when there is no signature.
4. Staff checklist for the moment a patient says they want to go.
5. LAMA, DAMA and absconding register, with a monthly LAMA rate.

• Word (.docx), editable; add your letterhead.
• PDF, print-ready A4.
• Excel (.xlsx), for the register and the monthly rate.

Free to use and adapt, no sign-up. For the discharge summary itself, our free discharge summary generator has a LAMA template that prints on your letterhead.

PM-JAY’s guidelines for special cases define it plainly: “Leave Against Medical Advice (LAMA), also called discharge against medical advice (DAMA), is an act whereby a patient takes his/her discharge contrary to the recommendation or will of the attending physician.” NABH and NQAS use LAMA for the same thing. Some hospitals split the words, using LAMA for emergency or OPD patients and DAMA for admitted ones; Meghalaya’s government form does this. Either way the record is the same.

• LAMA / DAMA: the patient tells you, is counselled, and signs.
• Absconding:the patient leaves without telling anyone. There is no signature, so staff record when they were last seen and by whom, search, inform the family, and, under government hospital procedures such as AIIMS Rishikesh’s, the police.
• Refusing a specific treatment while staying admitted is covered by the same NQAS standard and can use the same form.
• “Discharge on request” has no official definition we could find. If the doctor does not advise discharge, treat it as LAMA.

No to both, in practice. In Common Cause v Union of India (2018), the Supreme Court said that “an adult human being of conscious mind is fully entitled to refuse medical treatment”. NABH lists the refusal of treatment among patient and family rights. The AIIMS Rishikesh medico-legal manual puts it bluntly: the treating physician “can not forcibly detain” a patient.

On bills, the Health Ministry’s Charter of Patients’ Rights makes settling the agreed payment the patient’s responsibility, and says a transfer to another hospital “will not be refused ... even if the patient is leaving against medical advice (LAMA)”. The Delhi High Court said in 2017, as reported, that custody of patients cannot be withheld even if dues are outstanding. So record the dues on the form and recover them like any other debt; do not hold the patient back.

NABH’s 6th edition hospital standards, under AAC.12, the discharge process:

• AAC.12 b:discharge is coordinated across departments and agencies, “including medico-legal and absconded cases”.
• AAC.12 c:“Written guidance governs the discharge of patients leaving against medical advice.” You need a LAMA policy, not just a form.
• AAC.12 d:“A discharge summary is given to all the patients leaving the organisation including patients leaving against medical advice.”

NQAS, the national quality standard for public hospitals, is just as direct in its assessor’s guidebook: there must be “an established procedure for patients who wish to leave hospital against medical advice or refuse to receive specific treatment”; assessors check that a “declaration is taken from the LAMA patient” and that a discharge summary is given to patients going in LAMA; and it tracks a monthly LAMA rate. For a private hospital working towards NABH, see our guide to NABH for small hospitals.

Write the declaration as an acknowledgement of facts (I was told, I understood, I chose, I was given the summary, I may come back), not as a promise that the hospital is not liable for anything. Pair it with the consent form she signed on admission.

Yes. NABH AAC.12 d and NQAS both ask for it, and the next doctor who sees the patient needs it more than anyone. Mark it clearly as LAMA, with the condition at the time of leaving, the medicines, and when to come back or go to the nearest hospital.

Some hospital procedures say otherwise: the AIIMS Rishikesh manual tells staff not to issue a discharge summary if the patient or attendants refuse to sign. We would follow NABH and NQAS, which are the standards a private hospital is assessed on: give the summary, and record the refusal to sign with two staff witnesses. Our discharge summary guide covers what goes in it.

Refused to sign:write it in the case sheet at the time, with what was explained and in which language, and have two staff members sign as witnesses. Still give the summary and the advice. The AIIMS Rishikesh manual asks the doctor to “record the same on the file of the patient” when the family refuses to write anything.

Absconded:note when the patient was found missing, who last saw them and when, what treatment was running, the search, and when the family was told. Government procedures such as AIIMS Rishikesh’s say the police are informed of every absconding, whether or not it was a medico-legal case, and that no medico-legal case is discharged without informing the police. We found no national law that sets this for private hospitals; follow your hospital’s medico-legal policy and local police practice. Our pack has an absconding report for all of this.

We found no Indian rule written specifically for LAMA. Good practice: for a minor, the parent or guardian signs; for an adult who cannot understand or decide (unconscious, confused, severely ill), the relative or legal representative signs, and the form says why the patient is not signing. The doctor writes a short note on capacity: oriented, understands the risks, can repeat them back. For a psychiatric patient, check the Mental Healthcare Act, 2017 and your hospital’s policy before relying on a relative’s signature.

It helps, as part of the record. In two National Consumer Disputes Redressal Commission cases, as reported by Medical Dialogues, the hospitals were not held negligent:

• In Jairam Sahu v Chandulal Chandrakar Memorial Hospital (2017), the Commission noted that LAMA was recorded in the hospital’s discharge document and that the relatives took the patient on their own responsibility.
• In Tarlok Chand Mattu v Vasal Hospital (2017), the Commission said that where the patient left against medical advice and nothing showed that due care had not been taken, no negligence could be attributed to the doctors.

Our reading: what helped was a record made at the time, of LAMA and of the care given, not a waiver clause. So the form works alongside a complete indoor case paper. Separately, the Supreme Court in March 2026 was reported to have disapproved of the “routine practice” of discharge against medical advice for dying patients, in an end-of-life case. LAMA has to be the patient’s choice, not the hospital’s convenience.

PM-JAY’s May 2020 guidelines for special cases, which replaced earlier ones, say the hospital is paid a partial amount only if it reports the deviation on the IT platform “not later than 24 hours” (72 hours for public hospitals), and only after an audit:

• LAMA after surgery: 75% of the package rate, with daily case sheets and OT notes.
• LAMA before surgery:paid as a medical stay, at the daily package rate for the days admitted by bed category. Uttarakhand’s claims FAQ says no payment in this case, so check your State Health Agency’s current rule.
• Medical cases:the daily package rate for the days admitted, with clinical notes for each day; the FAQ also asks for an “indemnity consent” note, so keep the signed LAMA form with the claim.

For private insurance, we found no IRDAI rule on LAMA. In practice the insurer or TPA will want the discharge summary marked LAMA, the signed form, the final bill and the case papers, so a missing summary is what stalls a reimbursement claim.

Neither NABH 6th edition nor the Gujarat rules name a LAMA register, but NQAS measures a monthly LAMA rate and absconding rate by record review: for the emergency department, the number of LAMA cases times 100, divided by patients seen at emergency. A register is the simplest way to have that number. For wards, divide by admissions and say so. The reasons column is the useful part: a rising “financial” count is a billing problem, not a clinical one.

In Gujarat, the indoor patients register prescribed by the Clinical Establishments Rules has a “Result” column with only cured, same condition, referred or expired. Write the condition and add LAMA beside it, for example “same condition, LAMA”. See our IPD register format.

A LAMA happens fast, often at night, so the form must be on the ward and the steps must be known. Software helps with what comes after: the consent and the summary on the same admission, printed in the patient’s language. MedStream keeps consents in English and Gujarati against the admission and prints the discharge summary from the same record; see how the indoor ward fits on our nursing home software page. Whatever you use, the free discharge summary generator will print a LAMA summary today.