The disclosure of information to patients on the subject of code status is variable as there is a lack of evidence based practice or standardized disclosure of information. Multiple articles and studies have been reviewed which illustrate such a deficit but do not indicate how to either create or implement evidence-based practice to address this deficit. The review of literature will further illustrate the knowledge and communication deficits between patients and providers with code status discussions. The purpose of this study was the creation and evaluation of a standardized discussion/disclosure of code status information and a checklist of topics completed between the provider and patient. This checklist evaluation was trialed in an outpatient cardiology practice. Since this study was based on an ease of access and understanding, the checklist mainly focused on suggestions for change or improvement by the sample population. The methods of evaluation for the code status checklist would consist of qualitative data based on a post evaluation survey. The proposed checklist was well received with the sample population.