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Date of Death: [date name="variable_1" default="today"]
Time of Death: [text name="variable_2" default="11:59 AM"]
Provider Pronouncing Death: [text name="variable_3"]
Cause of Death:
[textarea name="variable_4" default="Cardiopulmonary arrest."]
Examination Findings:
[textarea fillable="true" name="variable_5" default="Absence of pulse, respiration, pupil response. "]
[textarea fillable="true" name="variable_6" default="Family ***present/not present/informed***. ***Attending physician notified.*** ***Pastoral care notified.*** ***Social work notified.***"]
[checkbox memo="display/hide references" name="footnotes" value=""][conditional field="footnotes" condition="(footnotes).isNot('')"]
[link url="" memo="#1"] University of Alabama at Birmingham - BEACON Project[/conditional]
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