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Sub-Acute and Rehabilitation Center Admission Agreement Mobile App

This is the Sub-Acute and Rehabilitation Center Admission Agreement app. This agreement is used for clients who do not wish to be resuscitated or have any cpr performed on them in the case of cardiac arrest or if found without signs of life during a rehab session. There is also an area of the app that has other procedures the resident can opt out of, some of these procedures include, lab work, blood infusions, pain management measures, etc... At the end, the User will sign their name in the app as approval for the treatment requested or refused. This app is easy to use and can be tailored to your specific needs, all wording can be changed and customized the way you want it, according to how you want the information displayed.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Sub-Acute and Rehabilitation Center Admission Agreement Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico date

    Date

  • Ico time

    Time

  • Ico textbox

    Resident Name

  • Ico date

    DOB

  • Ico checkbox

    Full Code

  • Ico statictext

    A DNR (Do Not Resuscitate) code status had been approved by the resident or legal representative.

  • Ico statictext

    All residents are encouraged to remain in our facility where they know their caregivers and are c...

  • Ico checkbox

    DNR-NO CPR (Cardiopulminary Resuscitation).

  • Ico checkbox

    NO Intravenous therapy to include antibiotics or fluids for hydration.

  • Ico checkbox

    NO Artificial means of feeding to include NG, G or J tubes

  • Ico checkbox

    NO hospitalization related to illness or primary diagnosis, not to include traumatic injury.

  • Ico checkbox

    NO antibiotic therapy to include oral, intravenous or intramuscular injection.

  • Ico checkbox

    NO lab work

  • Ico checkbox

    NO blood or blood product infusions

  • Ico textbox

    Other

  • Ico checkbox

    Comfort Measures to include pain management related to end of life care only.

  • Ico textbox

    Resident

  • Ico signature

    Resident

  • Ico date

    Date

  • Ico statictext

  • Ico textbox

    Responsible Party

  • Ico signature

    Responsible Party

  • Ico date

    Date

  • Ico statictext

  • Ico textbox

    MD

  • Ico signature

    MD

  • Ico date

    Date

  • Ico textbox

    I, the undersigned, do hereby agree with Cedar Crest Sub-Acute & Rehabilitation Centre ("the faci...

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