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Critical

Situation Notification


Guardian(s) for ___Mingzhou He_______,


Our patient Mr. / Ms. __Mingzhou He_____ is now being treated in the Respiration
Department, who has been diagnosed to have _____high blood pressure, cerebral atrophy,
Adams-Stokes disease, asthma, pulmonary infection_______.

Right now, this patient is in a critical health condition that might lead to death in the following
treatment. So now, we have the responsibility to give you this Critical Situation Notification. In
spite of this, we will still act positively and do whatever we can to treat this patient with our
professional medical knowledge and ethics.

We hope you family members can understand, cooperate and support us.

If you have any concerns or request, we are welcoming you to tell us as soon as possible when
you receive this Notification.


Signature from physician-in-charge: __LI Shi___
Department: __Respiration__
Time: __August 25th, 2013____

Signature from guardian: ___Deyu He___
Relationship with the patient: ___Son___
Time: __ August 27th, 2013_________



(This Notification has two copies of the same content, one for Hospital, and one for guardian(s))

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