Puskesmas as the primary implementation of basic health service efforts for the community in their working areas have a role in organizing health efforts to increase awareness, willingness and ability to live healthy for every resident in order to obtain optimal health degrees, so as to carry out health efforts, both first- level public health efforts and other health efforts. First-level individual health care requires an integrated and sustainable Puskesmas management in order to produce an effective and efficient Puskesmas performance. Patient refusal in an emergency condition is something that cannot be done by the Puskesmas for any reason. Patient refusal in an emergency condition is something that cannot be done by the Puskesmas for any reason. Regarding Decision No. 112/Pdt.G/2020/PN Lbp discussed the case of refusal of emergency patients by the Puskesmas in the Deli Serdang area. Later in this paper, we will discuss how the basis for regulating the responsibility of the Puskesmas for handling emergency patients and the legal consequences for the Puskesmas if they do not fulfill their obligations in handling emergency patients. The research method used is normative legal research or library research that examines document studies, using various primary and secondary data. The results of this study are the rules governing Puskesmas have been regulated in Law Number 29 of 2004 concerning Medical Practices, Law Number 36 of 2009 concerning Health and Minister of Health Regulation 43 of 2019 concerning Health Centers. The legal consequences obtained by the Puskesmas are administrative sanctions in the form of verbal warnings, written warnings, temporary suspension of activities, and/or revocation of operational permits, while the criminal sanctions return to the rules of the Health Law based on Article 190 paragraphs (1) and (2) of the Law. Health. The conclusion obtained is that there is harmonization between regulations related to Puskesmas in Indonesia, but there is still a lack of socialization to health workers. In the future, there needs to be a policy from the Department Health as an agency that has the authority to supervise the performance and services of Puskesmas so that similar things do not happen again.