Relatives:

Sex, age, bed number and medical record number of the patient.

Diagnose as

Now he is in our hospital. Despite active treatment, the condition is getting worse and worse, which may be life-threatening at any time. I hereby issue an urgent notice.

Nevertheless, we will still treat it positively, please understand and cooperate. If you have other requirements, please tell our department immediately after receiving the "notice of critical illness".

Doctor's signature:

Date: year, month, day and hour

Signature of relatives:

The relationship between relatives and patients:

ID number:

Date: year, month, day and hour

Hospital department

(This notice is in duplicate, one for the hospital and one for the patient's relatives)