48,851
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Line 11: | Line 11: | ||
*Admit date. | *Admit date. | ||
*Admit diagnosis. | *Admit diagnosis. | ||
**History of illness prior to admission | **History of illness prior to admission? | ||
*Past medical history. | *Past medical history. | ||
** | **Recent hospital admissions? | ||
*State preceding death | **Significant medical conditions. | ||
*State preceding death - especially the last 24 hours. | |||
**Level of consciousness. | **Level of consciousness. | ||
**Vitals. | **Vitals. | ||
Line 26: | Line 27: | ||
**Other. | **Other. | ||
*Date and time of death. | *Date and time of death. | ||
*Clinical | *Clinical status prior to death. | ||
**Unexpected versus unexpected. | **Unexpected versus unexpected. | ||
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