Get Mortality Review Template

Filling out the Mortality Review Template is crucial for ensuring an accurate and comprehensive review of the mortality event. This guide provides clear, step-by-step instructions to assist users in completing the template online efficiently and effectively.

Follow the steps to fill out the Mortality Review Template accurately.

1. Press the ‘Get Form’ button to access the Mortality Review Template and open it for editing.
2. Begin with Section I, Personal Information. Fill out the individual's first name, middle initial, last name, DMH number, address, county of residence, date of birth, age, and gender. Ensure all fields are accurately filled.
3. Proceed to the Guardian Information section. Provide the guardian's name, agency name, addresses and phone numbers accurately.
4. Detail the race/ethnicity of the individual, checking the appropriate box based on the options listed.
5. In the Background Information section, describe the individual's level of independence, special care needs, supervision needs, and any physical disabilities.
6. Indicate the level of supervision required by checking all applicable boxes and provide information regarding any altered levels of supervision.
7. Fill out the Death Information section, specifying the location, date, and time of death along with any relevant details regarding CPR instructions and directives.
8. List the most current medication orders, detailing each medication currently taken by the individual, along with dosage.
9. Outline any medication changes that occurred in the three months prior to the death event, including any alterations in dosage.
10. In the Recent Medical History section, list all medical events, visits, and significant changes in the individual’s health status for at least six months prior.
11. Cover the events leading up to the death in a detailed chronology, outlining significant actions and occurrences.
12. Address any potential abuses or neglect by indicating yes or no, and describe actions taken if necessary.
13. Conclude by ensuring all required documentation is attached and that signatures from relevant professionals are included at the end of the form.
14. After completing the form, save changes, download, print, or share the form as necessary.

Complete the Mortality Review Template online to ensure a thorough and accurate review process.