Fraser Valley Animal Hospital

2633 Ware Street
Abbotsford, BC V2S 3E2

(604)854-2313

www.fvah.ca

QUALITY OF LIFE FORM
(The HMMMMM Scale)

Pet care givers can use this Quality of Life Scale to determine the success of Pawspice Care.


Score your pet using a scale of 0-10 (10 being ideal)
*TOTAL - *A total over 35 points represents acceptable life quality to continue with pet hospice (Pawspice)

 

Quality of Life Form

Clients Name (required)
First Name (required)
Last Name (required)
Phone (required)
Phone TypePhone Number (required)
E-Mail Address (required) :
Patients Name (required)

HURT - Adequate pain control & breathing ability is of top concern. Trouble breathing outweighs all concerns. Is the pet’s pain well managed? Can the pet breathe properly? Is oxygen supplementation necessary? (required)
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Please explain:

HUNGER - Is the pet eating enough? Does hand feeding help? Does the pet need a feeding tube? (required)
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Please explain:

HYDRATION - Is the pet dehydrated? For patients not drinking enough water, use subcutaneous fluids daily or twice daily to supplement fluid intake. (required)
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Please explain:

HYGIENE - The pet should be brushed and cleaned, particularly after eliminations. Avoid pressure sores with soft bedding and keep all wounds clean. (required)
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Please explain:

HAPPINESS - Does the pet express joy and interest? Is the pet depressed, lonely, anxious, bored, or afraid? Can the pet’s bed be moved to be close to family activities? (required)
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Please explain:

MOBILITY - Can the pet get up without assistance? Does the pet need human or mechanical help (e.g., a cart) Does the pet feel like going for a walk? Is the pet having seizures or stumbling? (required)
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Please explain:

MORE GOOD DAYS THAN BAD- When bad days outnumber good days, quality of life might be too compromised. When a healthy human-animal bond is no longer possible, the caregiver must be made aware that the end is near. (required)
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Please explain:


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