This form is far more detailed than the basic cardiac arrest form. It requires a serious commitment from an agency to support the collection of information. It requires 1-3 hours of time to gather this information and review it and code it properly. However, once entered into a data base this information is invaluable in monitoring a community’s survival rate and in indentifying areas needing improvement. This form is in a Word document so that local agencies can customize it to their needs.