The first people's Hospital of Jiashan County， Zhejiang Province
Notification of Critical Illness
Name： panda Gender： female Dept： ICU Bed No.： 502-13 Medical record No.： 00367556
This is a critical/serious illness notification. Doctors will inform the diagnosis and treatment related matters in an easy to understand way.
一、Current diagnosis：
①. Cerebral Infarction
②. Left Internal Carotid Artery Occlusion
③. Grade 3 Hypertension (very high risk)
④.Cardiac Pacemaker
⑤.Arrhythmia
⑥.Cardiac Insufficiency
⑦. Pulmonary Infection
⑧. Liver Cirrhosis
二、Current condition： Critically ill
三、At present， the patient's condition is critical and may deteriorate further. One or more of the following life-threatening complications may occur at any time：
(1) Pulmonary encephalopathy， severe arrhythmia， heart failure， myocardial infarction， hypertensive crisis.
(2) Upper gastrointestinal bleeding leads to hemorrhagic shock， cerebral hemorrhage， cerebral infarction and cerebral hernia.
(3) Septic toxic shock， anaphylactic shock and cardiogenic shock.
(4) Diffuse intravascular coagulation.
(5) Multiple organ failure.
(6) Diabetic ketosis， acidosis， hypoglycemic coma， hyperosmolar coma：
(7) Others.
四、Preventive measures：
(1) Once a life-threatening condition occurs to a patient， the medical staff will give full treatment， including tracheotomy， ventilator assisted breathing， electric defibrillation， cardiac compression， temporary pacemaker installation and other measures
(2) According to relevant laws and regulations， in order to rescue the patient， the medical staff can first take rescue measures for the patient without your consent， and use the equipment and treatment methods required for emergency treatment， and then perform the obligation of notification. Please understand and cooperate with the rescue.
Interview physician： Zhang dog Signature Date： July 31， 2026 11:10
The doctor has informed the patient of the current condition， possible risks and consequences， and agreed with the medical staff to treat the patient in critical condition.
Signature of patient/agent： Shen Qiuyan Signature Date： July 31， 2026 14:50
通知详情/NotificationDetails（中英文翻译对照）
尊敬的家属：
TotheFamilyMembers:
患者目前病情严重，生命体征不稳定，经我院医疗团队评估，已符合病危状态。具体病情如下：
The patient is currently in a severe condition with unstable vital signs. After evaluation by our medical team， the patient meets the criteria for critical condition. Details are as follows:
诊断/Diagnosis
急性心肌梗死并发心源性休克
Acute Myocardial Infarction complicated by Cardiogenic Shock
多器官功能衰竭（心、肺、肾）
Multiple Organ Failure (Heart, Lungs, Kidneys)
当前状况/CurrentCondition
依赖呼吸机辅助通气
Dependent on ventilator support
持续使用升压药物维持血压
Continuous vasopressor infusion to maintain blood pressure
意识昏迷，格拉斯哥昏迷评分（GCS）为6分
Comatose state with Glasgow Coma Scale (GCS) score of 6
风险说明/Risks
病情可能进一步恶化，随时面临心跳呼吸骤停风险。
Condition may deteriorate further with risk of sudden cardiac or respiratory arrest at any time.
尽管全力救治，仍存在不可预测的并发症及生命危险。
Despite full efforts, unpredictable complications and life-threatening risks remain.
后续措施/FurtherMeasures
持续加强监护与生命支持治疗。
Continue intensive monitoring and life support treatment.
必要时需进行紧急干预（如心肺复苏、体外膜肺氧合等）。
Emergency interventions (e.g., CPR, ECMO) may be required if necessary.
家属确认/FamilyAcknowledgment
我已理解患者病情危重及相关风险，并同意医院采取必要的医疗措施。
I understand the critical condition of the patient and the associated risks, and I consent to necessary medical measures.
签名/Signature：________________________
日期/Date：________年/Year________月/Month________日/Day
联系电话/ContactNumber：________________________
医院信息/HospitalInformation
医院名称：仁和医院
HospitalName:RenheHospital
地址：北京市朝阳区健康路1号
Address: No. 1 Jiankang Road, Chaoyang District, Beijing
主治医生：李华
AttendingPhysician:LiHua
联系方式：010-12345678
Contact:010-12345678
签发日期：2026年3月21日
IssuedDate:March21,2026
注意事项/ImportantNotes
本通知书旨在告知病情实况，请家属保持通讯畅通。
This notification aims to inform of the actual condition. Please keep communication channels open.
如需进一步沟通，请随时联系主治医生或ICU值班医护。
For further communication, please contact the attending physician or ICU staff on duty.
（本文件为中英文对照，以中文内容为准）
(This document is bilingual, with Chinese version being authoritative.)