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MC 3834 (10/95)--front Vanderbilt University Medical Center CODE STATUS PROGRESS NOTE (Insert in sequence in Progress Note section) BOTH SIDES OF THIS FORM MUST BE COMPLETED IN FULL, INCLUDING LEGIBLE SIGNATURES, WITH EACH CHANGE IN A - mc

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MC 3834 (10/95)--front Vanderbilt University Medical Center CODE STATUS PROGRESS NOTE (Insert in sequence in Progress Note section) BOTH SIDES OF THIS FORM MUST BE COMPLETED IN FULL, INCLUDING LEGIBLE SIGNATURES, WITH EACH CHANGE IN A - mc Preview on Page 1

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The document is a Code Status Progress Note from Vanderbilt University Medical Center, designed to record and communicate a patient's resuscitation preferences, including options for Do Not Resuscitate (DNR), Do Not Intubate (DNI), or Limited Cardiopulmonary Resuscitation (LCPR). It requires detailed completion regarding the patient's diagnosis, prognosis, decision-making capacity, reasons for code status orders, discussions held with relevant parties, treatment goals, and additional comments. The form emphasizes the importance of clear communication and documentation of patient wishes regarding end-of-life care.

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