Death Record – Rescue Management System

Your Name *

Pet Tag Number *

Date of Pet admission *

Date of Pet death *

Death Time (Approximately) *

Cause of Pet death *

Kindly mention in 15-20 words as what could be the cause of the death of the pet

Informed the owner of the pet death? *

Yes
No

If no, why? *

Informed Via? *

Phone Call
SMS- Owner’s number is switched off or not reachable
WhatsApp- Owner’s number is switched off or not reachable

Informed the treatment and condition of the pet: *

General Condition: Good or Debilitated
Vital organs: Stable or abnormal
Temperature: Normal or hypothermia or hyperthermia
Pain Intensity: Location of the pain on the body
Vomiting: Yes or No
Diarrhea: Yes or No
Appetite and food intake: Good intake or Less intake
Urination: Proper or Improper with yellowish color or blood in urine
NA

Note: The call closing should not be as scripted above and should be natural and empathize the reporter in natural conversation. The intention of the call is to provide as much as information to the reporter about the pet.

Granted permission for the burial? *

Yes
No

If no, why? *

Treatment Record (Diagnostic, Medical history, Blood reports etc.) *

Click or drag files to this area to upload. You can upload up to 100 files.

Any Comments?