# Tips for BLS transports.



## goidf (Jul 16, 2008)

where I work, there is a lot of joking (and griping) about us (and I guess most privet ambulance companies) being a taxi company with paper work. Nothing makes that seem more true then making a transport and getting a tip at the end of it. 
Does anyone have any thoughts, is there anything that could be wrong with accepting a tip for a BLS transport?


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## Flight-LP (Jul 16, 2008)

Legally (generic blanket statement) and ethically it is wrong to even consider. If you want to be a taxi driver, go drive a cab. Otherwise, consider promoting your organization as a professionally run EMS service. If you can't then you should consider employment elsewhere.

I really wish we had emoticons, the one ramming his head into the brick wall would be nice about now....................


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## NESDMEDIC (Jul 16, 2008)

Personally i do not accept any gratuities. I do recieve thank you cards at my home residence with gratuites included with the card. I return the gratuities to the patient or the family with a note explaining the Thank you and the thought is sufficient. I just don't feel right accepting money from patients personally.


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## goidf (Jul 16, 2008)

gratuities?! what do you mean by that?! the guy just told us a quicker route! he gave us a driving tip to get to the destination faster. but what I was saying, is maybe we should not have accepted it, because it looks like we didn't know the fastest way...


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## NESDMEDIC (Jul 16, 2008)

Sorry I misunderstood your meaning, I do appolize. I understood tip's as money.


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## goidf (Jul 16, 2008)

OK, on a serious note. My gut was tells me that there is something wrong with it, but I am DEFINITELY NOT going to say a word to my partner. I'm new and the last thing I need is to alienated as some sort of better then thou goody good boy.
And look at it from the another point of view; I'm not talking about responding to an emergency. I am talking about shlepping someone down four flights of stairs on a stair chair, then loading'em into my bus, filling out a meaningless PCR, and accepting the payment for the ride (a few hundred for the transport, not talking about the tip here), so that the Pt. could go to the beach. Why shouldnt I be allowed to accept a tip?!
working at a privet company who's only real emergency's (at least BLS) are flag downs, you kinda get that feeling of being a taxi driver.
If I where doing my real job as an EMT I.E. providing emergency care, I wouldn't dream of accepting a tip, (then again, in those situations nobody is offering one). 
In this case, I am more interested in what other EMTs working in privet companies think about this, as I think anyone working 911 would be outraged by the mare idea...


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## skyemt (Jul 16, 2008)

goidf said:


> gratuities?! what do you mean by that?! the guy just told us a quicker route! he gave us a driving tip to get to the destination faster. but what I was saying, is maybe we should not have accepted it, because it looks like we didn't know the fastest way...



no need to change your tune and get defensive, own your comments....

you said  "Nothing makes that seem more true then making a transport and getting a tip at the end of it."

i think we would all agree that most do not wait until the "end" to give driving tips... lol

pretty clear what you intended here...


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## JPINFV (Jul 16, 2008)

Is accepting tips wrong? Well, it really depends on the situation. First off, if anyone is *expecting* tips, then this is the wrong field for you. Want more money, then negitioate a raise, find a different company, or find a different career path. Expecting patients to pay the ambulance company AND pay you as well is wrong. 

That said, I follow the "refuse 3 times" rule. There comes a point in time when refusing a tip becomes more insulting than simply taking it, understanding that it's the rare exception, being extremely grateful, and moving on with your day. Yes, it's 'wrong' (especially if providers come to expect tips), but sometimes it becomes the lesser of two evils.


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## mikeylikesit (Jul 16, 2008)

JPINFV said:


> Is accepting tips wrong? Well, it really depends on the situation. First off, if anyone is *expecting* tips, then this is the wrong field for you. Want more money, then negitioate a raise, find a different company, or find a different career path. Expecting patients to pay the ambulance company AND pay you as well is wrong.
> 
> That said, I follow the "refuse 3 times" rule. There comes a point in time when refusing a tip becomes more insulting than simply taking it, understanding that it's the rare exception, being extremely grateful, and moving on with your day. Yes, it's 'wrong' (especially if providers come to expect tips), but sometimes it becomes the lesser of two evils.


 not me i will only take it if they say "it will insult me, or i will feel bad if you don't take it."
that being said if you do get a tip i always put it toward buying food for the rest of the employees.


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## rhan101277 (Jul 16, 2008)

I don't understand, your saying you get dispatched on a 911 call and the person just needs a ride somewhere.  Do you pick them up run lights and siren to where they want to go, friends house, pizza hut etc.?


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## Sapphyre (Jul 16, 2008)

No, Rhan, EMTs don't only work 911.  They also work interfacility transport, and, it sounds like in this case, there's some sort of transport contract that takes homebound people to appointments, etc (am I getting this right?).  The tips are coming during the non-emergent but still medically necessary (?) transports


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## KEVD18 (Jul 16, 2008)

medically necessary..... thats a laugh.


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## rhan101277 (Jul 16, 2008)

Sapphyre said:


> No, Rhan, EMTs don't only work 911.  They also work interfacility transport, and, it sounds like in this case, there's some sort of transport contract that takes homebound people to appointments, etc (am I getting this right?).  The tips are coming during the non-emergent but still medically necessary (?) transports



oic, there are transports run in the little town I live in.  I just thought he/she was talking about something different.


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## Medic9 (Jul 16, 2008)

When I saw the title I was thinking they were asking what to do to make the trip better for the provider and pt. I surely hope that I read the post wrong because it is unethical to take money from a pt. We do this job because we like what we do. If you are in it for the money then you need to find a new job. Please understand that I am not picking or attacking anyone, I am speaking in general terms. 
I do many long distance transports and have found it to be beneficial to read the paper, ask them about their family, what do they do/did for a living, learn a little bit about everything so you can carry on a conversation with your patient. I have had patients tell me that it was a pleasure talking to me and I made the trip less stressful. Some patients would rather sleep or just rest and you have to learn the cues that thats what they want. Some people will continue to talk to be polite. 
Always be professional, try to stay far far away from religion and politics if you can help it or any other topic that may upset the patient.


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## Medic9 (Jul 16, 2008)

Sapphyre said:


> No, Rhan, EMTs don't only work 911.  They also work interfacility transport, and, it sounds like in this case, there's some sort of transport contract that takes homebound people to appointments, etc (am I getting this right?).  The tips are coming during the non-emergent but still medically necessary (?) transports



Yes, many places have those services. Some people need an ambulance or ambulette because of an injury that makes them non-weight bearing. Or they are non-ambulatory, morbidly obese etc.
Where I live they are 3 different companys that offer that service and then the sqaud that I work for will do transports if a doctor signs a medical necessity form.


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## BossyCow (Jul 17, 2008)

The word tip means "to insure promptness" which I think all of us accept as a given in EMS. It is acceptable in a restaurant where the waitperson may be serving several tables at once, and made sure that you were attended to with promptness and efficiency. Same with the hairdresser, housekeeping at the hotel, redcap at the airport etc. 

I think in healthcare that we assume that promptness is going to be understood as a matter of course. I also wouldn't tip the nurse practicioner at the Doc's office, my dental hygeinist, or any other healthcare provider.

In the service industry, perfunctory delivery of service is the standard. When we get more than that, we tip. To imply that this would in anyway translate into healthcare is ridiculous.


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## goidf (Jul 17, 2008)

I don't necessarily disagree with most of the negative reaction I am seeing here (like I said, I expected more outrage,but anyway) I am curious if any of you nay Sayers work (or have worked) at a privet company that does transports? I wonder how many of you really relate to what its like spending hours doing transports that any taxi could have done (only they wont carry a patient down on a stair chair) and not the long distance transports for the lack of closer medical facility, I mean the transports from home to the beach!


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## skyemt (Jul 17, 2008)

goidf said:


> I don't necessarily disagree with most of the negative reaction I am seeing here (like I said, I expected more outrage,but anyway) I am curious if any of you nay Sayers work (or have worked) at a privet company that does transports? I wonder how many of you really relate to what its like spending hours doing transports that any taxi could have done (only they wont carry a patient down on a stair chair) and not the long distance transports for the lack of closer medical facility, I mean the transports from home to the beach!



if you are not enjoying what you are doing, then perhaps it is not for you...

if you do enjoy it, why not put your time into doing it better, instead of griping.

no offense intended.


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## goidf (Jul 17, 2008)

no offence taken. I do actually enjoy doing it (I definitely ain't in it for the money) and there I go griping again ^_^.


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## JPINFV (Jul 17, 2008)

goidf said:


> I don't necessarily disagree with most of the negative reaction I am seeing here (like I said, I expected more outrage,but anyway) I am curious if any of you nay Sayers work (or have worked) at a privet company that does transports? I wonder how many of you really relate to what its like spending hours doing transports that any taxi could have done (only they wont carry a patient down on a stair chair) and not the long distance transports for the lack of closer medical facility, I mean the transports from home to the beach!




Yes, I have worked for a private ambulance service. No, I do not expect tips. No, the care provided does not change if I think I'm going to get a tip. No, I do not expect patients or their families to supplement my income past the money my employer pays me. If you want to work for a taxi company and get paid in tips, then there's nothing stopping you from going and driving a taxi.


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## goidf (Jul 17, 2008)

its not a question of expecting, or changing the quality or care, its a question of taking when offered.


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## WuLabsWuTecH (Jul 17, 2008)

I think its unethical as it could be seen as favoritism or that I will do more for a person if i know he will tip.  (We run on the same people at lot of the time, sometimes emergent, sometimes not).  Company policy is that we do not accept tips or gifts or any other things from our patients (except peds if they send us some arts and crafts project) but that we will also make the patient come first, and if they insist on it, the managers are ok with us taking it as along as we report it.  Nothing says we have to use it toward the company but i've only heard of them taking the gift card or whatever and buying food their shift.

I personally would not take a tip even if company policy said it was ok to.  While sometimes it seems like i'm driving a taxi, I'M NOT AN AMBULABCE DRIVER!!!  I'M A PROFESSIONAL EMT D**NIT!!!


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## mperkel (Jul 18, 2008)

*hmmm*

even coming from working in the restaurant industry, as an EMT i think it is also ridiculous to accept a tip. In healthcare, as healthcare providers we are always supposed to achieve a standard of going above and beyond. If we don't, we have failed at our jobs. By accepting a tip, your just lowering the standards of our profession to say this time i actually did my job. I would much rather receive a thank you for my kindness and professionalism then take money from people already charged too much in this industry.:blush:


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## volff21 (Jul 18, 2008)

goidf said:


> I don't necessarily disagree with most of the negative reaction I am seeing here (like I said, I expected more outrage,but anyway) I am curious if any of you nay Sayers work (or have worked) at a privet company that does transports? I wonder how many of you really relate to what its like spending hours doing transports that any taxi could have done (only they wont carry a patient down on a stair chair) and not the long distance transports for the lack of closer medical facility, I mean the transports from home to the beach!



why driving to a beach?who are we transferring care to?i do transports to but only to another medical facility,or, from the facility to home but not with out the medical necessity form.if they want to go to the beach give them the number for the taxi,maybe we can stop for a pizza on the way


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## BossyCow (Jul 18, 2008)

When someone offers a tip, I see it as their way of trying convey their gratitude for what we have done for them. I would never accept one, but you have to be careful that you refuse properly. Saying "I'm not allowed to accept tips" can be heard as.... "I really wish I could, but I can't let anyone know, so lets just keep this between us". Its important to me to let the pt or family member know that I sincerely appreciate the intent behind the offer, but that it truly isn't necessary. 

If you feel that tipping should be allowed, I would suggest you rethink your role as a transport.


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## goidf (Jul 18, 2008)

Thank you Volff! That is exactly what I am trying to harp on, how we are NOT talking about some emergency medical situation. You have good questions, and my only answer is: You obviously don't own a ambulance company. (don't feel too bad about that, I don't own one either ) The point is that the family called, and we hauled. we transferred care right back to the family (who came alone with us). The transport was somewhat necessary (pt being not very ambulatory) but far from an emergency. 
So in what way where we different from the bellboy who carried this families luggage up to their room at the hotel? 
Just a few quick  I do not (contrary to what this writing might convey) resent what I do, or people who call us for such transports. they call because they deem it necessary, and I haul because its my job. Secondly, I obviously am being vague as to what exactly the transport was from-to, privacy and all that, so the "beach" is just an example (you can interchange it with "spa, hotel, casino, whatever..." point being, it was not to a medical facility.


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## BossyCow (Jul 18, 2008)

> The point is that the family called, and we hauled.



I understand that there is a tendency to depersonalize the pt in those agencies that run frequent transports.. but you did not 'haul' you transported a pt, who due to their impaired health, needed to be cared for, not simply loaded into a truck and moved like a piece of furniture.



> So in what way where we different from the bellboy who carried this families luggage up to their room at the hotel?


Um.. right off hand.. Samsonite doesn't make grandmas. And if you see yourself no different from a luggage toter, than perhaps you need to rethink your career choice. I hear that in a good hotel, during tourist season the tips are awesome. 



> Just a few quick  I do not (contrary to what this writing might convey) resent what I do, or people who call us for such transports. they call because they deem it necessary, and I haul because its my job.



Well there ya go.. It's your job! I still have an issue with the term 'haul'. I would suggest that if your writing conveys a certain resentment, perhaps you should review what you have written and determine if there is some resentment in there that only needs another year or so of transporting before it does flare up into full blown resentment.



> Secondly, I obviously am being vague as to what exactly the transport was from-to, privacy and all that, so the "beach" is just an example (you can interchange it with "spa, hotel, casino, whatever..." point being, it was not to a medical facility



All calls need to be treated with deference to human dignity and respect. We all either die young or get old. Now, if the agency you work for has what we term 'paratransit' service and you are being used to ferry people to the grocery store, social events or other non-medical appointments, then perhaps a change to an agency that does more emergency response is in order. But I still say no tips. Its too easy to assume that you are being treated like a taxi driver, and we have all had the occasional abuser in the back of our rigs, but are you certain that the family didn't pay to have Aunt Martha taken to the 'spa, hotel, casino, whatever' because she had a relatively short time ahead of her and they wanted her to have a day out? Where's the shame in that? 

I really think you are trying very hard  to justify collecting tips. It's not working!


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## Airwaygoddess (Jul 18, 2008)

*That is a tip all by it's self.......*

What ever happened to having pride in our job and being proud of  a job well done........  What about being the patient's advocate?     -_-


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## skyemt (Jul 18, 2008)

wow... three pages about accepting tips in EMS?

and EMT's trying to defend it?

it's making the "what lights do you use" threads look pretty appealing...lol

think we are hitting a new low.

a bellhop dressed as an EMT is still a bellhop...


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## BossyCow (Jul 19, 2008)

skyemt said:


> wow... three pages about accepting tips in EMS?
> 
> and EMT's trying to defend it?
> 
> ...



Ya know, a post about how lame a thread is, is still a post to that thread!


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## Jon (Jul 20, 2008)

BossyCow said:


> ...In the service industry, perfunctory delivery of service is the standard. When we get more than that, we tip. To imply that this would in anyway translate into healthcare is ridiculous.



To play devils' advocate - here we get to the root of the question - is routine transport healthcare, or is it a service industry?

-Public Transit is a service industry
-Taxis are a service industry
-The local paratransit system is a service industry
-The wheelchair vans my service runs - aren't they about the same as the local paratransit - making them a service industry?
-I don't do anything more for most of my patients than our chair car drivers do for their clients... so I'm not really providing healthcare, am I?


The point of a tip, in circumstances other than a restaurant or similar environment (where it is pretty much expected) - is to reward exceptional service. If I take my job seriously, and give exceptional service - why shouldn't I be noticed and rewarded for it occasionally?

When I used to work transport full-time, we would occasionally get tips... Corporate policy didn't prohibit tipping. I NEVER expected one... but if the person insisted, I'd usually accept. It was never outside the $5-$10 range. We always shared between partners. I also usually worked with old-school City Firefighters who picked up part time transport EMS shifts for beer money and an excuse to not be home. They wouldn’t expect it… but they did almost seems to have an attitude of entitlement about tips, and never hd any problems accepting.

When I was working security - I received some odd gratuities - I once got a voucher for a free oil change when I coordinated the rescue of a visiting auto-body shop owner's cell Phone from a 8-foot-deep storm drain. Took 5 of us to get the grate up... Me and the other S/O with me said that the best thing he could do would be to write a letter to our boss (we were occasionally getting in trouble for stupid things... he did better, and called my boss's boss). I also received a couple of meal vouchers for helping out folks who locked their keys in their cars... I refused to accept cash (against policy) and usually just asked for them to send an email of appreciation... usually worked.


  Now that I’m working 911.. and I've grown up… No. No reason to. I'm in a medical job.

I guess I'm explaining why I did it... and also pointing out some other thoughts.


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## ffemt8978 (Jul 20, 2008)

skyemt said:


> wow... three pages about accepting tips in EMS?
> 
> and EMT's trying to defend it?
> 
> ...



That's because after the patient sees the bill from the medics, they can't afford to tip anymore.  

Seriously, I've worked private transport and vollied 911.  I've been offered tips at both but have always refused them.  For the private transport, I said it was against company policy.  From the 911 side, I've declined and asked that they instead make a donation to the department if they really wanted to do so.


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## goidf (Jul 27, 2008)

OK, so you just did this transport for this filthy rich Saudi Prince's mother. and you see him (the Saudi prince) handing your partner a $100, then he turns to you and offers you one as well. What would _you_ do? How would you turn it down without making your partner look like.... and without creating animosity between yourself and your partner? What if your partner (who does not have a problem taking tips) sees you turning down a big tip that should have gone to both of you? Are you so sure that tips are wrong that you would be willing to create an issue between yourself and your partner over it?


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## Airwaygoddess (Jul 27, 2008)

*Patient care and interactions.......*

If this is causing you so much grief I would suggest getting a new partner.  On a personal note, I would have a very hard time working with a partner that had that kind of "attitude" about tips.  What kind of a image does that portray to all of EMS?  Heaven forbid if the media should ever get a hold of that "information" and consider how the public would react.  Your partner needs to take a good hard look at what he considers right and wrong, and also needs to remember he is misrepresenting EMS.  Poor judgment affects all of us ......... -_-


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## goidf (Jul 27, 2008)

I don't have a steady partner, but this (being offered tips) did happen to me more then once (OK I admit, it only happened twice). with different guys, both of whom are (to the best of my knowledge) great guys. honestly it don't make that much of a difference to me, somehow I will deal with it. 
I do still think that its a interesting topic, how to balance your own morals and getting along with other people. and lets remember, we are not talking about abusing a patient (even one who deserves it). As for those who don't agree, and cant understand what there is to talk about, (wink wink skyemt) does it really bother you so much that there is a thread you find stupid? personally, when I see a thread I don't like, I use the Ridryder technique, JUST IGNORE IT! don't read it, and DEFINITELY don't add to it. but every man to his own...


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## Tiberius (Jul 28, 2008)

When I worked transports, I, too, recieved some offers for tips. My partner and I would only accept if, like another poster said, would greatly insult the patient, and the dollar amount would take care of a simple lunch. Most times we would tell the patient to call the office and/or write a commendation letter. I NEVER expect tips (if you expect tips, then wait tables or drive a cab) since we are here to provide medical care and (or, at least) comfort to our patients. I'm happy with simple thank-yous for all we do out here.


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## jordanfstop (Jul 28, 2008)

When I was doing transports throughout The Bronx we would have some pts who would try and tip us at the end. We would always pertinaciously refuse the money. One time we had an EDP of a pt that yelled and yelled at us and start freaking out and called us very rude. We kind of just walked out of the house thinking she'd get the idea, and then she tried chasing us (her beiing legally blind, we didn't think it would be the best idea.) There was that case and also another time where we had to drive a good twenty minutes (Code 3) (not normal response time for our area) mutual aid to another town at 2am. We took the pt and the mother was in the front. It was another good 30 minutes transport (Code 1) to the hospital. The mother ended up giving my driver $5 so we could buy ourselves some coffee. Besides those two instances (second one not being involved in) I've never accepted a tip.


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## BossyCow (Jul 28, 2008)

goidf said:


> OK, so you just did this transport for this filthy rich Saudi Prince's mother. and you see him (the Saudi prince) handing your partner a $100, then he turns to you and offers you one as well. What would _you_ do? How would you turn it down without making your partner look like.... and without creating animosity between yourself and your partner? What if your partner (who does not have a problem taking tips) sees you turning down a big tip that should have gone to both of you? Are you so sure that tips are wrong that you would be willing to create an issue between yourself and your partner over it?



If your moral compass has a declination that varies based on who's watching and what they would do in your place, then you have other issues besides whether or not to take tips.

Does the company you work for have a policy on taking tips? If they forbid it, and you have co-workers who are taking them, they will certainly have issues with your non-compliance with what they see as business as usual. If the company has a 'don't ask, don't tell' sort of blind eye tolerance for this sort of thing, then I would suggest you decide if this is the type of agency you want to continue working for. 

It's these little decisions that determine who we are and who we become in our careers and in our lives. We make them one at a time, often not seeing how they impact our progress in life until we're looking back on it 30 years later wondering.. "How did I get here?"


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## Ridryder911 (Jul 28, 2008)

My partner & I was offered $100 tips each for an AMA call involving a domestic abuse by a wealthy businessman. We both needed the money, but realize that it is unprofessional and unethical. 

I informed him that confidentiality was a given and did not have to be purchased, and he persisted. I informed to contact the business office in the morning, and if he still wanted to donate we had a charitable cause we take such money for and donate it. 

I have had patients bake me cookies, pies, even given me gifts in appreciation. This is not unusual as a nurse and sometimes as a Paramedic. Yes, I accept them because it given as a "thank you" and "appreciation" and is not usually at the time of the incident or occurrence. 

R/r 911


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