Euthanasia & Aftercare Note

(Time-stamp all critical events: consent, premedication, euthanasia agent start/finish, death confirmed, body released. Never infer consent, aftercare choice, or who was present—explicitly state or document as pending. Use respectful, neutral clinical language. If any required element—authorization, euthanasia method, death confirmation, or disposition—is missing at signing, record as not obtained with reason and note that an addendum will follow.)

Date/Time: [Date] | Time started: [Time] | Time signed: [Time]

Location: [Clinic room / In-home address / Field call / Other]

Attending Veterinarian: [Name, credentials]

Assisting Staff: [Names and roles]

Patient: [Name]; [Species]; [Breed]; [Sex/reproductive status]; [Age]; [Weight]; [Microchip ID if applicable]

Client/Authorized Agent: [Name]; [Relationship to patient]; [Contact information] (If agent rather than owner, state authority basis.)

Clinical Indication

[Clinical indication narrative] (Include primary medical or behavioral indication for euthanasia, clinical status today with key signs driving urgency, quality-of-life summary including functional impairments and suffering burden, and prognosis statement. Always include veterinarian's clinical rationale even if euthanasia is primarily owner-directed.)

Decision-Making & Consent

[Shared decision-making summary] (Document treatment alternatives discussed, owner's stated goals and values, veterinarian's recommendation and basis, and outcome of discussion. If alternatives were discussed at a prior visit, reference that note date and document what changed today.)

• Consent obtained: [Yes / No / Pending]; Time: [Time] (If pending, specify what element is missing and anticipated resolution.)
• Consenting party: [Name]; [Relationship]; [Verification method if remote]
• Consent method: [Written signature / Electronic signature / Verbal with witness / Pre-existing authorization on file] (If verbal, include witness name and role.)
• Scope of consent: Euthanasia [accepted / declined]; Aftercare/disposition choice [accepted / declined]; Keepsakes [accepted / declined / not offered]; Necropsy [accepted / declined / not offered]
• Key points reviewed: Expected procedure course; possible peri-mortem events (agonal breaths, muscle movements, urination/defecation, eyes remaining open); patient-specific risks if any.

Procedure

Pre-euthanasia assessment (Time: [Time]) — Mentation: [Alert / Depressed / Obtunded / Unresponsive]; Respiratory effort: [Normal / Increased / Labored]; Pain/anxiety appearance: [Description]; IV access: [Catheter placed / Direct venipuncture]; Site: [Vein/location]; Success: [Description]. Client presence: [Present throughout / Present for sedation only / Declined presence / Other].

Premedication: [Used / Not used] (If not used, state reason: patient obtunded, emergent circumstances, owner declined, or other.)

Medication	Dose	Route/Site	Time	Administered By	Response
[Premedication/Sedative]	[Dose]	[Route; site]	[Time]	[Name/role]	[Response]
[Euthanasia agent]	[Dose]	[IV / IC / IP / Other; site]	[Time]	[Name/role]	[Response]

(Add rows as needed for all medications administered.)

Procedure narrative: Euthanasia agent administration started: [Time]. Completed: [Time]. [Observed physiologic course including loss of consciousness, cessation of respiration, and any agonal movements described objectively]. (If intracardiac or other nonstandard route used, document confirmed unconsciousness prior to administration and clinical justification.)

Complications: [None / Description with times and actions taken] (Include only if complications occurred: difficult IV access, extravasation, prolonged time to death, unexpected response, staff injury. Omit this field entirely if uncomplicated.)

Death Confirmation

Time of Death: [Exact time death confirmed]

Criteria: [Absent heartbeat by auscultation / Absent respirations / Absent corneal reflex / Other signs] (Document all criteria used.)

Confirmed By: [Name, role]

Aftercare

Immediate postmortem care: [Catheter removal, cleaning/positioning, keepsakes prepared, personal items returned] (List all that apply.)

Disposition: [Private cremation with ashes returned / Communal cremation / Owner takes body / Burial / Other] (Must be explicit; do not infer.)

Custody Transfer: Body released to: [Name/organization]; Time: [Time]; Identification attached: [Tag/label method]; Storage location if pending: [Location]

Return of Cremains: [Yes / No / N/A]; Anticipated timeline: [Timeframe]; Notification method: [Method] (If rabies testing or other circumstances affect disposition, document routing instructions.)

Documentation & Follow-up

Controlled Substances: [Yes / No]; Log entry recorded in: [System/log reference] (Do not duplicate full inventory details.)

Client Communication: [Who was notified]; [Aftercare next steps and timelines explained]; [Bereavement resources offered: Yes / No / N/A]

Follow-up Items: [Outstanding items and plan for follow-up contact] (Include crematory pickup pending, paw print, lab results, sympathy card, ashes notification as applicable.)

Attestation: I confirm that euthanasia was performed humanely, death was confirmed, and aftercare was arranged as documented above.

[Signature]; [Credentials]; [License number if required]; Time signed: [Time]