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.
- FHA Palliative Patient Community Rx (aka "Drug Kit").
- FHA_Community_EOL_order_V3_Feb15_2021.zip. Text digitized to allow for proper spacing.
- Revera End of Life Orders: Revera_EOL_order_V4_Oct27_2021.zip
- Updated with detuned submit/print buttons; more medication cues, and incorporation of signature stamp. The signature default can be reset to "wet signature" within the code.
- FHA Actively Dying Protocol for residential care (EOL orders): V3
- This one includes digital wet signature and signature stamp if that is set up.
- DNR No CPR eFORM: V12_Jan26_2021_FNW_version
- 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. Corrected signature save function when some, but not all signatures are completed on eFORM.
- DNR No CPR eFORM: V13_Jan26_2021_FNW_version
- Same as V12, but with signature stamp option.
- DNR No CPR eFORM: V12_Jan26_2021_FHA_generic_version
- This version removes the FNW references. Works best with addition of Notification of Expected Home Death eFORM - see link below. Fix saveSig glitch where last signature not saved if first two are blank. Signature stamp option added.
- Substitute Decision Maker: Substitute_Decision_Maker_V21_Sep7_2021.zip
- Updated with 2021 features, including font-size changers.
- 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
Document Actions
