Patients leaving the emergency department (ED) against medical advice (AMA) represent 0.1% to 2.7% of all ED patients. These patients create significant angst for emergency physicians because these patients frequently have serious underlying medical pathology and tend to represent a higher-than-average source of medical-legal liability than other ED patients. This article attempts to mitigate these risks by reviewing what we know about AMA encounters from the ED and providing documentation guidelines for the encounter.