At the hospital were I work as the Coordinator, patients, when going through the registration process, are all given a brief questionaire that introduces them to the Bloodless Medicine program, and asks,"If the need should arise during your hospitalization for the need of a blood transfusion...I would or I would not accept." The patient marks their choice. If they come through the ER department, the NO BLOOD bracelet is put on by the registration personnel. If they are a direct admit, then the bracelet is suppose to be put on by the nurse who does their admisson, but unfortunately, this does not always happen. I get a report several times per day showing all patients in-house who are registered as Bloodless, so I can follow-up in a timely manner. I make sure the patient understands what it means to be bloodless. Some patients who are intially "tagged" as being bloodless, turn out to be OK with receiving a transfusion if it's a life or death situation, so in those situations, the NO BLOOD bracelet is removed, and these individuals are put on blood conservation...got a bracelet for that too.