For a 40 year old, I have a come to jesus moment. I say you need this for your a. fib, or whatever, or you're gonna throw a clot and have a stroke. If you don't want to take it, that's fine, but that's a choice you're gonna be making. I tell them that we administer medications at set times to maintain effective prophylaxis. I'll jot a quick note, and if I have the time call the whoever ordered it and inform them of the refusal. If they want to place an ORDER for me to leave medication by the bedside, I will. But that's what it would take for me not write a refusal to take medication on the time it's ordered as anything but a refusal.