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Brothers Chauhan
Brothers Chauhan

COVID-Ward PGI CHD

Health & Medicine
1 of 1
Date: I have beeninformedaboutthe critical conditionof the patientandtheirneedforventilatorsupport. The hospital haslimitedventilatorsandcurrently,none are available.Despiteknowingthe severe conditionandlackof ventilatory/superspecialtycare inthishospital,Iwantto continue treatmentinthis hospital.Nodoctoror hospital staff will be responsibleforanymishapincludingdeathof the patient. Relative Name andRelation: Sign: Date: I have beeninformedaboutthe critical conditionof the patientandtheirneedforventilatorsupport. The hospital haslimitedventilatorsandcurrently,none are available.Despiteknowingthe severe conditionandlackof ventilatory/superspecialtycare inthishospital,Iwantto continue treatmentinthis hospital.Nodoctoror hospital staff will be responsibleforanymishapincludingdeathof the patient. Relative Name andRelation: Sign: Date: I have beeninformedaboutthe critical conditionof the patientandtheirneedforventilatorsupport. The hospital haslimitedventilatorsandcurrently,none are available.Despiteknowingthe severe conditionandlackof ventilatory/superspecialtycare inthishospital,Iwantto continue treatmentinthis hospital.Nodoctoror hospital staff will be responsibleforanymishapincludingdeathof the patient. Relative Name andRelation: Sign: Date: I have beeninformedaboutthe critical conditionof the patientandtheirneedforventilatorsupport. The hospital haslimitedventilators andcurrently,none are available.Despiteknowingthe severe conditionandlackof ventilatory/superspecialtycare inthishospital,Iwantto continue treatmentinthis hospital.Nodoctoror hospital staff will be responsibleforanymishapincludingdeathof the patient. Relative Name andRelation: Sign:

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Prescription 1

  • 1. Date: I have beeninformedaboutthe critical conditionof the patientandtheirneedforventilatorsupport. The hospital haslimitedventilatorsandcurrently,none are available.Despiteknowingthe severe conditionandlackof ventilatory/superspecialtycare inthishospital,Iwantto continue treatmentinthis hospital.Nodoctoror hospital staff will be responsibleforanymishapincludingdeathof the patient. Relative Name andRelation: Sign: Date: I have beeninformedaboutthe critical conditionof the patientandtheirneedforventilatorsupport. The hospital haslimitedventilatorsandcurrently,none are available.Despiteknowingthe severe conditionandlackof ventilatory/superspecialtycare inthishospital,Iwantto continue treatmentinthis hospital.Nodoctoror hospital staff will be responsibleforanymishapincludingdeathof the patient. Relative Name andRelation: Sign: Date: I have beeninformedaboutthe critical conditionof the patientandtheirneedforventilatorsupport. The hospital haslimitedventilatorsandcurrently,none are available.Despiteknowingthe severe conditionandlackof ventilatory/superspecialtycare inthishospital,Iwantto continue treatmentinthis hospital.Nodoctoror hospital staff will be responsibleforanymishapincludingdeathof the patient. Relative Name andRelation: Sign: Date: I have beeninformedaboutthe critical conditionof the patientandtheirneedforventilatorsupport. The hospital haslimitedventilators andcurrently,none are available.Despiteknowingthe severe conditionandlackof ventilatory/superspecialtycare inthishospital,Iwantto continue treatmentinthis hospital.Nodoctoror hospital staff will be responsibleforanymishapincludingdeathof the patient. Relative Name andRelation: Sign: