Death of Elvina Roloff

February 8, 2001. Time: 0030 (12:30 AM)
Hospice Southwest Postdeath Checklist.
Patient: Roloff, Elvina
Date of Death: 2/7/01
Reported Time of Death: 2345 (11:45 PM) 2/7/01
Reported by: SIL (son-in-law) Dan
Time of RN Visit: 0030 2/8/01

List Medications Destroyed:
Lorazepan tabs/ intensol
Roxanol

(Note: quantities are not recorded.)

Witness Signature: Marie Cheatham.