Resuscitation Code Status Form (CPR / DNR)
Owner’s decision on resuscitation in hospital
01
Client & patient
02
About resuscitation
Cardiopulmonary resuscitation (CPR) is an attempt to restart the heart and breathing using chest compressions, breathing support, and emergency drugs. Even with prompt CPR, many pets do not survive, and those that do often need intensive care afterwards.
03
My decision
Please initial each statement
- The options above and what they involve were explained to me, and my questions were answered.
- I understand that CPR often does not succeed, and that surviving pets may need further intensive care at additional cost.
- I may change this decision at any time by telling the hospital.
Owner / authorized agent signature
Veterinarian signature
04
Changes
Record any change of decision| Date & time | New status | Taken by | Cage card updated |
|---|---|---|---|
05
Cage card copy
Copy onto the cage card and treatment sheetCode status