English to Spanish Medical Names (personal, company) Medical Spanish interpreter

This is a transfer form used at the hospital I work at and it is used to transfer patients from one hospital to another. I am having trouble trying to use the right Spanish words for "transfer refusal." Can anyone help?

:^>Thanks
Yolie

This is how it reads on the form:

3. Transfer Refusal
I acknowledge that my medical condition has been evaluated and explained to me by a physician who has recommended that I be transferred. The potential benefits/risks of transfer and the probable risks of not being transferred have been explained to me and I fully understand them. Even though Dr. __________________________ believes it is in my best interest to be transferred, I refuse to be transferred and I request instead to continue receiving treatment at DOH.