A coalition of individuals and organization who seek to improve end-of-life care in Massachusetts. Maine, Texas, and New York are three states that allow the licensed RN the ability to pronounce death. Callanan, M. (2008).Final journeys: A practical guide for bringing care and comfort at the end of life. `in:"$:DR-~%pl:I. %W`RR6`4,2A2b:, sa3Xf G\"@l-ltx%@vm 8 ] AMU6*0C;y PM1@"hTMIj6XP)2V]ptf1CYPkhj.| 7$;D&^MH5y]2bD@.Hv0@2aLfpa#jC}&.XT,lK2BZR/\t2 WBRaHNZ@n.ly!1D)m=bY@dHY6 Legal forms may also be found through Gale LegalForms. Family at bedside. Specializes in LTC. 7-62-2. 6 0 obj If you cannot find a form you need, you can contact the Trial Court Law Libraries and they will assist you. 4 0 obj 9 0 obj 0 Byock, I. Pediatric Palliative Care Network (PPCN) 0000058102 00000 n By Ida Koivisto, BSN, RN, PHN. PDF Pronouncement of Death by Licensed Nurses Purpose Policy ongoing education that they can access twenty four hours a day, at home }=y\Ev_]&c9\-,l)QhR|t_a PDF Pronouncement of Death Guidelines - Nurses Callanan, M., & Kelley, P. (1997).Final gifts: Understanding the special awareness, needs, and communications of the dying. endstream 7 0 obj 0 $,et&; order for rn pronouncement. MK=l6SUQK>SHMX5iIm5Q7aY.nM WYS"J:thFVveCS.1BcFz|eh;qdNJ.[N:d#7P!,lhBSH*E,%fyZO]Z6ypCO{-5~28 &0(0jlGDCG.87|372/ QX 8^ For Massachusetts patients, the form for pronouncement of death is the Pronouncement of Death Form by the Registry of Vital Records and Statistics in the Commonwealth of Massachusetts. I never understood the rationale of taking bp. Determination of prognosis by physician Honoring Choices Specializes in Gerontology, Med surg, Home Health. Simply placing pronouncement of death by RN or something similar in the search bar of your search engine can identify other states. 393 0 obj <>stream Page 1 of 2. CBC& *U2M>}{x,`C2?YG9}0)+ -a} 5IO>`}W+*]fHv*/L5dz*^e+;D[Jdhr;s:e rjV7}hhe-;Zvwb{i-l1Jip"y_Ue`!O^wR= .ERFc9Osqztf&{A=Kx7a(}oL>wNe[$D^r:Y0daGddz8_, Death within 24 hours of admission to a hospital or nursing home 6. for physicians, nurses and other health care professionals. 3. We barely have functioning dynamaps let along EKG machines. 705 0 obj <>stream Select the Get form key to open the document and begin editing. search parameters, plus information about the data such as format, We will update and add resources on a continuing basis. Telephone: 305-538-9272, Hospice and Palliative Nurses Association A nursing organization of over 9,200 members dedicated to promoting excellence in End-of-Life nursing Innovations in End-of-Life Care An international, online journal, committed to more humane, comprehensive, and coordinated care for dying persons and their families. Please let us know how we can improve this page. New York: Springer Pub. allnurses is a Nursing Career & Support site for Nurses and Students. PDF PRONOUNCEMENT OF DEATH (REVISED 04/2018) - Georgia Department of Public (c) "Anticipated Death" is death which is, in the opinion of the attending physician, expected due to illness, infirmity or disease. We had one heavy set resident who was a beast in regards to pulses. 0000006264 00000 n directly to tabular, graphic or narrative data. "`.LL@1l?q#QrP4w >stream Epidemiology of Dying & End-of-Life Experience New York: Broadway Books. >x.4Q9c=@6{&q0 More %PDF-1.5 Download this form to order Pronouncement of Death Forms from Massachusetts Department of Public Health. (Take picture of your license and keep in phone, or on a slip of paper with your forms). Body released to MacVille Funeral Home. Our members represent more than 60 professional nursing specialties. General Law - Part I, Title XVI, Chapter 114, Section 45 MEDICAL EXAMINER DEATH CERTIFICATE - Massachusetts Thanks. endobj Bell, K. W. (2010).Living at the end of life: A hospice nurse addresses the most common questions. Ostaseski, F., & Zen Hospice Project. A lock icon ( Always check your own facility's policy for RN pronouncements.and don't forget, sometimes the nurse CAN'T pronouncean unexpected death, a death within 24 hours of admission (unless the person came in to die)the circular letter from this state is about 3 pages long on when to call the ME. CPR, Artificial Feeding, Comfort Care, and the Patient with a National Hospice and Palliative Care Organization, Office of the Inspector General IG Compliance Program, Guidance for Hospices. RCW 70.58.160 unless the nurse is an Advanced Registered Nurse Practitioner (ARNP) or certified nurse midwife as defined in . Death is a very serious thing to announce legally and there are a lot of consequences for doing it. Co. Wrede-Seaman, L. (1999).Symptom management algorithms: A handbook for palliative care. Post mortem care is provided (refer to agency . An international, online journal, committed to more humane, comprehensive, and coordinated care for dying persons and their families. 17 0 obj allnurses, LLC, 175 Pearl St Ste 355, Brooklyn NY 11201 PDF Pronouncement of Death by a Registered Nurse - ct hkJp L=0HegeJa,( o. Death Pronouncement: Survival Tips for Residents | AAFP Section 45: Burial permits; permits for removal of bodies; certificates of death; deceased veterans. Have forms and black pens with you. Guidelines 6 c. removing any medical equipment or drains (except for autopsy cases); d. assisting with any postmortem tissue or sample procurement; and e. assisting with processes for organ or tissue transplantation. endobj If your complaint is not resolved by your hospice team, or if you feel uncomfortable discussing it with them, you should contact the administrator of your hospice. New York, N.Y: Bantam Books. Center to Advance Palliative Care:prepared byThe Joint Commission (TJC)Certification Process, DPH Forms - Death Pronouncement http://www.healthcareproxy.org/, Massachusetts MOLST Massachusetts Medical Orders for Life Sustaining Treatment. Resident assessed, BP/P/R absent, Pupils fixed. Online Resources and Recommended Readings. Wogrin, C. (2001).Matters of life and death: Finding the words to say goodbye. Some page levels are currently hidden. Thorofare, N.J: Slack. Overview "Legal forms" are forms that are not filed in court, such as forms for taxes, contracts, wills, and the like. PDF Expected Death in the Home (EDITH)Guideline Remen, R. N. (1996).Kitchen table wisdom: Stories that heal. 0000001138 00000 n PDF Arizona State Board of Nursing Death by poison or acute/chronic use of drugs or alcohol 4. 1 0 obj New York: Jeremy P. Tarcher/Penguin. 290 0 obj <>/Filter/FlateDecode/ID[<62DBEB941E88F1428ACE081799A7268D>]/Index[272 45]/Info 271 0 R/Length 86/Prev 157303/Root 273 0 R/Size 317/Type/XRef/W[1 2 1]>>stream xXn8}GHiQuZYt6>}%Vw. (Effective August 2, 1994) Sec. )nYBaa3c, A nurse may determine and pronounce death, but shall not certify death as defined in . pupils fixed. It is completed according to the instructions on the reverse side of the . Massachusetts Legal Forms by Subject | Mass.gov endobj Buscaglia, L. F. (2002).The fall of Freddie the leaf: A story of life for all ages. One also has to know the difference between death and the other states that an individual might be in at the time. For Massachusetts pronouncements you must have your RN license number with you. Order to release body to funeral home received. 1901 N. Moore Street #901 lol. Use this button to show and access all levels. National Hospice & Palliative Care Organization { 15 0 obj Has 7 years experience. Massachusetts legal forms for subjects A-D, Massachusetts legal forms for subjects E-H, Massachusetts legal forms for subjects I-L, Massachusetts legal forms for subjects M-P, Massachusetts legal forms for subjects Q-T, Massachusetts legal forms for subjects U-Z. QksaG+ofZ69O=rIH(T8Gq^Q[/NR7/{# iKq0XU*yUFkoqC0S-r=J%Z7AnfUYdkY-{EZH6DhW`z m^@G[+!xPCm}@ ALGY yT+}8/$`4T(Wt!b@%n@6@rG>m2w04;~5{ 48j]f)[3IBC:A5nDe`'X2 /(v[QY:J1 f0vdBdUmCZ\qz}7D51H e cFUVco6J5oRWG@iiJIf53(lNKCf H;$M?j Tg8 <> The RN s role is limited to the pronouncement of death after an assessment of the patient. Resident DNR. problems." By this statute an RN has the authority to make an assessment and therefore, a determination of death. YC" #OX] PDF Determination and Pronouncement of Death - Washington State Department Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac. 4. Do nurses have the authority to pronounce death? - Nurse.com Blog Order received for RN pronouncement. Boston, MA: Pauline Books & Media. L\ddEwexo_{Twu~_~M~>~~a`O?o76z8m-}|'iHN6Kdg*WiBShNc&U2^o?qOu{Uz/~YSofw{fmo?[{~[fhSm*MYizlg/;:#/$mK)mqmIG^Tz9F*j-1OL\2WL&:Mt4i2&ci24^~^5o O#%[r6# The obligation also must conform to the RN's or APRN's legal and ethical mandates. hZ7!>Y/;oFd:0f!tkTaUCUR kRI Top-requested sites to log in to services provided by the state. 0000003631 00000 n v fG#i}aH#ia8ZK]EV?X0T1dQSIf_x,v$XuhI(I(PRPr .4Yel^|NXCqo8Ur8^*s( =% New York: Riverhead Books. 3.1.18 Registered Nurse Pronouncement of Death (a) Policy California Correctional Health Care Services (CCHCS) shall permit Registered Nurses (RNs ) to make the determination and pronouncement of patient death under specified circumstances. I always put that the absence of vitals was confirmed by another nurse and the time that was done. Wn,.uIp$MyzI._zr%`;n/NYd 'g ,y:fb`ai\MOMw@WD{X =K"@. <> Death of any child under the age of 18 years from any cause 7. The pronouncement of death form should be completed by every person pronouncing the decedent at the facility and a copy should be given . New York, N.Y: Bantam Books. <> 13 0 obj For your convenience, we have provided a number of links to valuable services and helpful information. Mesothelioma Cancer Network <> Good answer? A. http://www.homelesshope.net/ Please limit your input to 500 characters. If you need assistance, please contact the Trial Court Law Libraries. sFg;fEe=RAEv-T);~1Z_F mg|!d}o4- it,: !m`M)HjMrl! A guide to enable patients or their advocates to make informed decisions about health care choices that reflect each person's goals, values, wishes and needs; outlining the types of choices that patients have when they are going through treatment for a serious life-limiting illness. website provides links to public data on decedents, cause of death and Complete Pronouncement Of Death Form in just several minutes by using the instructions below: Find the document template you require from our library of legal forms. pt was dnr. New York: Riverhead Books. 436 0 obj <>stream was developed by The Carolinas Center for Hospice and End of Life Care pt found w/o pulse, respirations. endstream endobj 39 0 obj <>/Metadata 5 0 R/PieceInfo<>>>/Pages 4 0 R/PageLayout/OneColumn/OCProperties<>/OCGs[40 0 R]>>/StructTreeRoot 7 0 R/Type/Catalog/Lang( E N - U S)/LastModified(D:20070918092624)/PageLabels 2 0 R>> endobj 40 0 obj <. <> (2009).The art of death midwifery: An introduction and beginner's guide. Since 1997, allnurses is trusted by nurses around the globe. Form R-360 07012014. Massachusetts law about nurses | Mass.gov for Nursing Services, or Chief Nurse Executive is responsible for ensuring that designated RNs, APRNs, and PA's covered by this policy are trained and competent in the procedures necessary to assess and pronounce a CLC resident's death in circumstances allowed herein. Has 30 years experience. <>/ExtGState<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> hospices by county and general information about hospice. Offers 3/6/2023Pedi Pal Spiritual Care Group Meeting, 3/6/2023Pedi Pal Social Work Group Meeting, 3/6/2023Charting for the Jury: Fine - Tune Documentation for Hospice & Home Care, 3/7/2023HCI Scoring & Developing PIPs Part 1, 3/9/2023Spiritual Care Coordinators Meeting, HPCFM 20 Commercial Drive, Suite One Wrentham, MA 02093, 781-255-7077 It is also emotionally demanding, and, because of the widespread misunderstanding of the law in Massachusetts, it can be difficult. <> Stickney, D., & Hernandez, G. O. General Law - Part I, Title VII, Chapter 46, Section 9 spoke with dtr on phone. St. Pierre, P. J. This trailer << /Size 39 /Info 15 0 R /Root 18 0 R /Prev 119813 /ID[] >> startxref 0 %%EOF 18 0 obj << /Type /Catalog /Pages 14 0 R /Metadata 16 0 R /PageLabels 13 0 R >> endobj 37 0 obj << /S 108 /L 181 /Filter /FlateDecode /Length 38 0 R >> stream Oxford: Oxford University Press. Yakima, WA: Intellicard. Has 7 years experience. experience of end of life. mx4JG=w' "($CrVH '!~~0c|HuYdb:g4Fg)S'~~;Z+bc'P6>ek,X Arlington, VA 22209 Only Sections 1431 and items 46 are- to be completed by the R egistered Nurse according to the instructions on the back of the form. IF YES, DATE (Month DD, YYYY) 0000001931 00000 n 0000000880 00000 n %PDF-1.6 % Specializes in LTC, rehab. Office of the Inspector General IG Compliance Program, Guidance for Hospiceshttp://oig.hhs.gov/authorities/docs/hospicx.pdf. <> New York: Macmillan. It provides a forum for members to engage in cross-continuum collaboration to address regulatory and clinical barriers that impede caregivers vital work. A resource for professionals, patients and their families regarding end-of-life decisions time-consuming Internet research has been done by EDELE researchers. Hospice Helpline: 1-800-658-8898 Institutional policy may also guide the nurse's role in the assessment of death. PDF Pronouncement of Death by a Registered Nurse - ct care professionals in training. The Policies and procedures of institutions Any institution, as defined in subsection (a) of section 19a-490 of the Connecticut General Statutes, which employs a registered nurse functioning pursuant to these regulations shall . It provides a forum for members to engage in cross-continuum collaboration to address regulatory and clinical barriers that impede caregivers vital work. I had a patient once whose wife refused to believe he was dead because she "didn't hear any alarm go off like on ER" I had to explain the difference between an 02 concentrator and a telemetry monitor and she still wouldn't believe her husband was dead. Get Pronouncement Of Death Form - US Legal Forms ), Tuesdays with Morrie: An old man, a young man, and life's greatest lesson, Close to the bone: Life-threatening illness and the search for meaning, The fall of Freddie the leaf: A story of life for all ages, Dying well: Peace and possibilities at the end of life, Final gifts: Understanding the special awareness, needs, and communications of the dying, Final journeys: A practical guide for bringing care and comfort at the end of life, Lessons for the living: Stories of forgiveness, gratitude, and courage at the end of life, Ten thousand joys & ten thousand sorrows: A couple's journey through Alzheimer's, Midwife for souls: Spiritual care for the dying, The art of death midwifery: An introduction and beginner's guide, Waterbugs And Dragonflies: Explaining Death To Young Children, Matters of life and death: Finding the words to say goodbye, Living at the end of life: A hospice nurse addresses the most common questions, Hospice and palliative care: The essential guide, Scope and standards of hospice and palliative nursing practice, The art of being a healing presence: A guide for those in caring relationships, Hospice and palliative care: Concepts and practice, Grief counseling and grief therapy: A handbook for the mental health practitioner, Symptom management algorithms: A handbook for palliative care, Living with dying: A guide for relatives & friends, Being a compassionate companion: A series, After the Hospital: A Guide to Post Acute Care, Guide to Help Palliative CarePrograms Successfully Complete, End of Life Palliative Educational Resource Center, pidemiology of Dying & End-of-Life Experience, Growth House: Guide to Death, Dying, Grief, Bereavement, and End-of-Life Resources, Hospice and Palliative Nurses Association, Know Your Choices: A Guide for Patients with Serious Advancing Illness, Massachusetts Commission on End of Life Care, Massachusetts Compassionate Care Coalition, National Hospice & Palliative Care Organization, http://oig.hhs.gov/authorities/docs/hospicx.pdf, http://dhi.health.state.nm.us/elibrary/hflcregs/Appendix%20M.pdf, Charting for the Jury: Fine - Tune Documentation for Hospice & Home Care. is Hospice, we notify Hospice, also. specifically, the site has been designed for use by medical school Massachusetts Medical Society George Washington Institute for Spirituality and Health New York: Guilford Press. (Effective October 20, 1988.) Bolen, J. S. (1996).Close to the bone: Life-threatening illness and the search for meaning. A nursing organization of over 9,200 members dedicated to promoting excellence in End-of-Life nursing, Innovations in End-of-Life Care Family, MD, Admin., and DON notified. endobj ]-X#=@.>9,Do|rK. Association Management Software Powered by, For your convenience, we have provided a number of links to valuable services and helpful information. HW}#_M%7V online, searchable catalogue of data about care at the end of life. h. Registered Nurse, Advance Practice Nurse, or Physician Assistant. A professional membership organization providing a web site on health care proxy, advance directives, discussion guides, and links to other resources. MHA and its Continuum of Care Council would like to acknowledge the many clinicians, partners, and organizations that contributed to the creation of this guide. directors, medical faculty, community preceptors, or other professionals Growth House: Guide to Death, Dying, Grief, Bereavement, and End-of-Life Resources hb``f``8* b kA.a gId8`8 9&~fl6 x*H(|b>a}BB ~fY*l4PdPvMcJ2l5>s@W&df 2@f'~w@= y #p Role of the LVN . endobj Telephone: 850-681-2010, Guide to Help Palliative CarePrograms Successfully Complete When a S.l. At 10am resident's respirations noted absent, RN supervisor notified. An RN's assessment or determinant of death does not include the medical certification of death. non-profit organization devoted exclusively to hospice. Garden City, N.Y: Anchor Press/Doubleday. endstream endobj 231 0 obj <. Resources - Hospice & Palliative Care Federation of Massachusetts endstream endobj 59 0 obj <>/Size 38/Type/XRef>>stream What would you include in a nurse's note for an RNdeath pronouncement? 0000002851 00000 n Miller, J. E., & Cutshall, S. C. (2001).The art of being a healing presence: A guide for those in caring relationships. The requirements as outlined in WAC 246-839-830 would apply: Determination and Pronouncement of Death . PDF California Department of Corrections and Rehabilitation - Cchcs WAC . dQ0xf$OM f+?! I had to call the doc to come pronounce. The Registered Nurse will notify the physician after the pronouncement of death. Mm(SojN9UJRG5 ' eWMDaDo9p8QV*[fA c^ OsNx Suggestions are presented as an open option list only when they are available. DEATH CERTIFICATE MEDICAL CERTIFIER WORKSHEET . Guidelines for Burial or Cremation without a Funeral Director Caring for your own dead can be immensely rewarding and help ease the pain of grief. Telephone: 617-618-2185. This page is located more than 3 levels deep within a topic. Connor, S. R., & Connor, S. R. (2009).Hospice and palliative care: The essential guide. 8 0 obj New York: Scribner. 0000003670 00000 n Users can search by topic, state, or a set of pre-written questions. body released to _______fh at 4pm. 0000060779 00000 n xzg)WC1!D(T}&20El1303i031^g``}qNF10 iFSo(eX6IH330UI20%b` we"f San Francisco, CA: Institute on Dying (Zen Hospice Project). Texas law provides for RN pronouncement of death. Sheehan, D. C., & Forman, W. B. (1992). Chapter 3, Article 1 3.1.18, Registered Nurse Pronouncement of Death . 'I7[wzw$ %%EOF PalliativeDoctors.orgConsumer Web site that explains the specialty of hospice and palliative medicine and its benefits to patients and families. PDF This document is a sample policy only and is intended to provide Know Your Choices: A Guide for Patients with Serious Advancing Illness A guide to enable patients or their advocates to make informed decisions about health care choices that reflect each person's goals, values, wishes and needs; outlining the types of choices that patients have when they are going through treatment for a serious life-limiting illness. @a2!lL}N,* bGF7p)ko,_)&$3SS(@Y^}%{vw9sh Purchasing directions for "Five Wishes," a simple document to put your "wishes" in writing should you become seriously ill and unable to speak for yourself. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 17 0 R/Group<>/Tabs/S/StructParents 1>> hbbd``b`z$ HX bHv`U= YDA 8Qd#io + WAC 246-840-830 identifies the requirements for the RN to determine and pronounce death. PDF ORIGINAL DATE: 03/01/93 - hhvna.com Massachusetts laws MGL c.30A, 14 Judicial review Notifies the MRP / RN(EC) of the patient's death, noting date and time of death, receiving funeral home : BookSurge. 0000000787 00000 n In the rare event that your complaint remains unresolved, you may contact the Hospice & Palliative Care Federation of Massachusetts or the Department of Public Health's Patient Protection Line. National Resident pronounced at 10.30AM. 11 0 obj Before making a pronouncement of death, a nurse practitioner shall make a reasonable effort to contact the attending physician or medical examiner. If you need assistance, please contact the Trial Court Law Libraries. MD notified, new orders - RN Pronouncement and order to release body to funeral home confirmed by Jane Doe NP covering for Dr John Doe. RN/ PA/ NP PRONOUNCEMENT? 8. endobj See the. Massachusetts Department of Public Health's Patient Protection Line. This study guide will help you focus your time on what's most important. endobj Washington, D.C: American Nurses Pub. MD stated he will notify the family. x]O8Lc;NVawXj/\q'I9v!%4|f:b 9>&zIit(0~c]99]L/a,VuyBdO|%"Z)smh S WsB ( 0000006498 00000 n <> Pronouncing patient's death should be timely, respectful - Nurse.com Registered Nurse (RN). Called to room by CNA at 4pm and noted resident without pulse, respirations or BP. Hospice and Palliative Nurses Association., & American Nurses Association. We will use this information to improve this page. endobj National Hospice and Palliative Care Organization : Continuum. Any person found dead (For complete list, see Pronouncement of Death Fact Book, 1999, page 13 . 230 0 obj <> endobj 7-62-3. Hard Choices for Loving People: New York: Routledge. New York: Doubleday. &pH&!QVeI)0E6rFQ0}a ^ jVe%X z3QFyPgS#gJ*D,>. Johnson, S. (1984).The precious present. Hoblitzelle, O. endobj PDF DEATH PRONOUNCEMENT CHECKLIST Required Orders 2. State Operations Manual Appendix M - Guidance to Surveyors: Hospice (Rev.) 3 0 obj 0 O!62H4|C&p. State in your note what you observed when assessing the resident, that a DNR was in effect, MD notified, family notified, and don't forget the time of death, and the time that the md and family were notified. MHA and its Continuum of Care Council would like to acknowledge the many clinicians, partners, and organizations that contributed to the creation of this guide. Create well-written care plans that meets your patient's health goals. Life-Threatening Illness, by Hank Dunn, A & A Publishers, Inc. 4th "Legal forms" are forms that are not filed in court, such as forms for taxes, contracts, wills, and the like. or in the office. Honoring Choices Massachusetts is a consumer focused non-profit organization supporting the right of every adult to direct their health care choices. If pt. endobj Fill in all of the requested boxes (they are yellow-colored). or in the office. 1-612-816-8773. 5. State Operations Manual Appendix M - Guidance to Surveyors: Hospice (Rev. It D8*$[UH m Edition, 2001 (2000).Being a compassionate companion: A series. stream Telephone: 617-964-1196. Worden, J. W. (1991).Grief counseling and grief therapy: A handbook for the mental health practitioner. A comprehensive resource guide and directory of end-of-life care resources and services available throughout Massachusetts. NYNewGrad said: Specializes in NICU, PICU, Transport, L&D, Hospice. The laws and rules do not specifically address whether the LPN can determine and . 0000024154 00000 n 0000083688 00000 n %%EOF endobj Davidson, G. W. (1990).Living with dying: A guide for relatives & friends. %PDF-1.6 % http://smhs.gwu.edu/gwish/about/contact. Choosing a specialty can be a daunting task and we made it easier. http://dhi.health.state.nm.us/elibrary/hflcregs/Appendix%20M.pdf, RECOMMENDED READINGS: PATIENTS AND CAREGIVERS. When a patient dies in a licensed hospice or a nursing home in the absence of a physician and under specific circumstances, that person may be pronounced dead as provided by law in GA Code Ann, 31-7-16 and .