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New York Do Not Resuscitate Order

This document serves as a Do Not Resuscitate (DNR) Order, created in accordance with New York State laws regarding advance directives and medical decision-making.

Patient Information:

  • Name: ________________________
  • Date of Birth: ________________________
  • Address: ________________________
  • Phone Number: ________________________
  • Health Insurance Provider: ________________________

Physician Information:

  • Physician's Name: ________________________
  • Physician's Phone Number: ________________________
  • License Number: ________________________

Patient's Wishes:

This Do Not Resuscitate Order expresses my wishes regarding resuscitative measures. By signing below, I indicate that I do not wish to receive cardiopulmonary resuscitation (CPR) or any other life-sustaining measures in the event of cardiac or respiratory arrest.

Patient Signature: ________________________ Date: ________________________

Witnesses (if applicable):

  1. Witness Name: ________________________ Signature: ________________________ Date: ________________________
  2. Witness Name: ________________________ Signature: ________________________ Date: ________________________

This form must be filed with your medical records, and a copy should be distributed to your healthcare providers and emergency contacts. Always keep accessibility in mind to ensure your wishes are respected.

Contact a healthcare professional for assistance in completing this order or if you have questions about your rights regarding medical decisions.

Documents used along the form

A Do Not Resuscitate (DNR) Order is an important document that allows individuals to express their wishes regarding resuscitation efforts in case of a medical emergency. In New York, this order is often accompanied by other forms and documents that provide further context or support for medical decisions. Below is a list of common documents used alongside the DNR Order.

  • Health Care Proxy: This document designates a person to make medical decisions on behalf of an individual if they are unable to do so themselves.
  • Living Will: A living will outlines an individual’s preferences for medical treatment in situations where they cannot communicate their wishes.
  • Medical Orders for Life-Sustaining Treatment (MOLST): This form provides specific medical orders regarding life-sustaining treatments and is intended for patients with serious health conditions.
  • Durable Power of Attorney: This essential legal document grants authority to an individual to act on behalf of another in various legal matters, providing peace of mind that one's interests are safeguarded even during incapacitation. It can be a vital complement to the Durable Power of Attorney form.
  • Advance Directive: An advance directive is a general term for documents that express a person's healthcare wishes, including a living will and health care proxy.
  • Patient Information Form: This form collects essential information about a patient’s medical history, preferences, and emergency contacts.
  • Do Not Intubate (DNI) Order: This order specifies that a patient should not be intubated in the event of respiratory failure, complementing the DNR Order.
  • Physician Orders for Life-Sustaining Treatment (POLST): Similar to MOLST, this document is used to communicate a patient’s preferences for treatment in a more portable format.
  • Emergency Medical Services (EMS) DNR Form: This form is specifically designed for EMS personnel to recognize and respect a DNR order during emergencies outside of a hospital.
  • Hospital Admission Orders: These orders may include a patient’s DNR status and other critical information that healthcare providers need to know upon admission.

Each of these documents plays a significant role in ensuring that an individual's healthcare preferences are understood and respected. It is essential for individuals to discuss their wishes with family members and healthcare providers to ensure clarity and alignment with their values and desires.

Similar forms

  • Living Will: This document outlines an individual's preferences regarding medical treatment in situations where they are unable to communicate their wishes. Like a Do Not Resuscitate Order, it focuses on end-of-life care and the types of interventions a person does or does not want.
  • Durable Power of Attorney for Health Care: This form allows a person to designate someone else to make medical decisions on their behalf. Similar to a DNR, it is used when a person cannot express their wishes due to incapacity.
  • Health Care Proxy: This document appoints an agent to make health care decisions for an individual. It is akin to a DNR in that both ensure that a person's medical preferences are honored when they cannot speak for themselves.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that reflects a patient's preferences for treatment at the end of life. It is similar to a DNR as it provides specific instructions about what types of medical interventions should or should not be performed.
  • EDD DE 2501 Form: The EDD DE 2501 form is essential for applying for Disability Insurance benefits in California, providing necessary financial support during recovery from illness or injury. To access the form, visit https://legalpdfdocs.com.
  • Advance Directive: This term encompasses both living wills and durable powers of attorney for health care. It serves a similar purpose to a DNR by ensuring that an individual's health care preferences are documented and respected.
  • Do Not Intubate (DNI) Order: This order specifically states that a patient should not be intubated if they cannot breathe on their own. Like a DNR, it is focused on limiting certain medical interventions.
  • Cardiopulmonary Resuscitation (CPR) Consent Form: This form indicates whether a person consents to or declines CPR in case of cardiac arrest. It is similar to a DNR in that it directly addresses resuscitation preferences.
  • Emergency Medical Services (EMS) Do Not Resuscitate Order: This is a specific form used by EMS personnel that indicates a person's wish not to receive resuscitation efforts in emergencies. It serves a similar function to a DNR by guiding emergency medical responses.
  • End-of-Life Care Plan: This document outlines a person's goals and preferences for care as they approach the end of life. It is comparable to a DNR in that it helps to ensure that care aligns with the individual's wishes.

Misconceptions

Understanding the New York Do Not Resuscitate (DNR) Order form is crucial for individuals and families making important healthcare decisions. Here are ten common misconceptions that can lead to confusion:

  1. A DNR means no medical care at all. Many believe that a DNR order prevents all forms of medical treatment. In reality, it only indicates that you do not wish to receive CPR in the event of cardiac arrest.
  2. Only terminally ill patients need a DNR. While DNR orders are often associated with terminal illness, anyone can choose to have one, regardless of their health status.
  3. A DNR is the same as a living will. A DNR specifically addresses resuscitation efforts, whereas a living will outlines broader healthcare preferences.
  4. You can’t change your mind about a DNR. People often think that once a DNR is in place, it cannot be revoked. However, you can change or cancel your DNR order at any time.
  5. A DNR is only valid in a hospital. Some assume that DNR orders apply only within hospital settings. In New York, DNR orders are valid in various healthcare environments, including at home.
  6. All healthcare providers will automatically know about my DNR. It’s a common misconception that healthcare providers will be aware of your DNR status. It’s essential to ensure that your DNR form is accessible and communicated to all relevant parties.
  7. Having a DNR means you are giving up on life. Many people fear that requesting a DNR signifies a desire to die. In truth, it reflects a personal choice about how one wants to be treated in specific medical situations.
  8. A DNR form is only for older adults. Some believe that DNR orders are only appropriate for seniors. In reality, individuals of any age can have a DNR if they choose to do so.
  9. You need a lawyer to create a DNR. While legal advice can be helpful, you do not need a lawyer to complete a DNR order. The form can be filled out by the individual or their healthcare proxy.
  10. Once signed, a DNR is permanent. Many think that a signed DNR order is unchangeable. However, it can be updated or revoked based on changing preferences or circumstances.

Being informed about these misconceptions can empower you to make better decisions regarding your healthcare preferences. Always consult with a healthcare professional to ensure your wishes are clearly understood and respected.

Understanding New York Do Not Resuscitate Order

  1. What is a Do Not Resuscitate (DNR) Order in New York?

    A Do Not Resuscitate Order is a legal document that allows individuals to refuse resuscitation efforts in the event of cardiac arrest or respiratory failure. In New York, this order is specifically designed for patients who wish to avoid life-saving measures, such as CPR, when they are unable to express their wishes due to a medical condition.

  2. Who can request a DNR Order?

    In New York, a DNR Order can be requested by any adult who is capable of making their own medical decisions. This includes individuals with terminal illnesses or those who are facing serious health challenges. Additionally, a healthcare proxy or a legally authorized representative can also request a DNR on behalf of a patient who is unable to make decisions.

  3. How is a DNR Order implemented?

    To implement a DNR Order in New York, the patient or their representative must complete the official DNR form. This form must be signed by a physician and can be presented in any healthcare setting. Medical personnel are required to respect the DNR Order as long as it is valid and properly executed.

  4. Can a DNR Order be revoked?

    Yes, a DNR Order can be revoked at any time by the patient or their representative. This can be done verbally or in writing. It is important to inform healthcare providers of the revocation to ensure that the patient’s current wishes are respected. Always keep a copy of the revocation for personal records.