Sample Death Note Template

Death Note: Template to Share Important Information of Patients

In a hospital, there are some patients that die in that place. As the people who work there, you need to provide a medical-legal document related to death. You can do the simple way. Yes, you can use the death note as the draft to make a document. With the printable death note template, you can still customize the contents based on your need. So, it will simplify you in providing medical-legal documents for the dead people.

18. Death Note

11 Most Necessary Things to Consider of the death note

In this template, there are some details that you should consider well. Make sure you fill it with the correct information. Here they are.

  1. The name of the patient

This is the most important thing to write in any medical-legal document. So, you should write it completely.

  1. Time and date of writing the note

The second, to present a valid document, you should write the time and date when you write the note.

  1. Short description of the patient’s death

To give briefer information, the note should contain a description of the events that lead to the patient’s death. Thus, everyone who reads it will understand the death chronology.

  1. CMO

In the death note printable, you can also explain whether the patient was comfort measures only when he or she dies. It is important to make the chronology of the death clearer.

  1. A physical exam

In the note of one’s death, you should write the physical exam report. That is why this template provides a blank to write that detail.

  1. Time of death

The family members or relatives usually want to know when the death of the patient. So, just write it using this template.

  1. Record attending

With this template, you can also make proof that the attending of record was clearly notified.

  1. Family notification

In the note of death, there is a detail to show whether the family was notified or not. So, you can make it happen with this template.

  1. Medical staff documentation

There is important documentation to show in this note. Well, it is related to the autopsy that was asked by the medical staff. Make sure you write this matter to complete the information on the patient note of death.

  1. Funeral home arrangement

To follow up on the patient’s death, there should be a funeral home arrangement in this note. Make sure you also write it clearly.

  1. Author’s signature

The document will be valid when it is signed legibly by the authors. As an author, make sure you sign the note first before submitting it. The space to sign is available at the bottom of the template.

Several Kinds of Sample Death Note

There are some samples of a template to use in the hospital that you can download freely. Have a good look at the samples below.

  1. Free medical death note template in word
  2. Note for brain death progress
  3. Notice of patient death
  4. Notice of hospital death
  5. Note of death pronouncement

Well, that is all about the death note sample you can recognize. Just pick one of them every time you need it.

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