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End Of Life Planning

Forms for End of life planning
CPR Advisor
This pulls from different sources/calculators to help guide patients in their different choices for resussitation options. This can be a standalone but is also linked to the MOST form.
End of Life care eForms 2014
For those who have taken/will take the End of Life (aka Palliative) Care Physician Support Program - these two forms were felt to be useful, especially the PPS one. The PPS one uses an unaltered background, as per the request of Victoria Hospice Society. I have approval from the Society to post it, with the request the background is unaltered. The ESAS form had to be flipped “backwards”, as I could not figure out how to get the drawing function to work on the 2nd page of a multi-pagers. Seems all the drawing forms used to date are on page 1. If someone can figure it out, I’ll be happy to reverse the pages to their original. Adding PPS to measurements is recommended for the PPS form. JohnY
Medical Orders for Scope of Treatment (MOST) form updated 2020
Contains available MOST for various Health Authorities: FHA, VCH, VIHA. Some have customization - e.g. fax cover page for the Fraser Health Authority ACP repository. Included hyperlinks to the Government web pages for Representation Agreements, section 7 and section 9. Created by JohnY.
Revera End of Life Orders: please consider using the V2 update
End of life order sheet for Revera operated residential care facility. Created initially for Royal City Manor in New Westminster, BC.
DNR No CPR: DNR_V11_Apr6_2020_FNWversion.zip
This version is customized for Fraser Northwest members - with links to Substitute Decision Maker eFORM designed with assistance from Dr. Charlie Chen, Notification of Expected Home Death, MOST, and ACP Record FHA version.
DNR No CPR: DNR_Generic_V11_Apr6_2020.zip
This version removes the FNW references. Works best with addition of Notification of Expected Home Death eFORM - see link below.
Substitute Decision Maker: Substitute_Decision_Maker_V20_Oct7_2018.zip
This new tool was developed in Fraser Northwest Division to enhance Advanced Care Planning in the community. It is meant to be a conversation starter for the patient and their significant others. It is linked to the updated Complex Care Lite form and the FNW version of DNR form. Feedback is welcome. JohnY
Link to Notification of Expected Death in Home eFORM
Link to Advance Care Planning eFORM, FHA version
Can be submitted to FHA ACP fax line
Revera End of Life Orders: Revera_EOL_order_V2_Sep13_2020.zip
Updated for increased consistency with FHA EOL (Actively Dying) orders.

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