The act of a patient to sign a document (release form) (1) refusing the recommendations of the physician and (2) releasing the physician and the hospital from liability-“signing himself out” (discharging himself) rather than being “signed out” (discharged) by the physician, which is the normal procedure-and leaving the hospital. The act of leaving the hospital without permission and not returning is tantamount to signing oneself out. Also called a “discharge against medical advice” or “AMA.”