Valid  Do Not Resuscitate Order Template for New Jersey

Valid Do Not Resuscitate Order Template for New Jersey

A New Jersey Do Not Resuscitate Order form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form is crucial for ensuring that a person's preferences are respected when they are unable to communicate. Understanding the implications and proper usage of this form is essential for both patients and healthcare providers.

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In New Jersey, the Do Not Resuscitate (DNR) Order form serves as a critical tool for individuals who wish to make their end-of-life preferences known, particularly regarding resuscitation efforts during medical emergencies. This legally recognized document allows patients to express their desire not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest or respiratory failure. Understanding the form's key components is essential for both patients and healthcare providers. The DNR Order must be completed and signed by a physician, ensuring that it reflects the patient's wishes and is supported by medical guidance. Additionally, the form requires the patient's signature or that of a legal representative, emphasizing the importance of informed consent. Families and caregivers should be aware that the DNR Order is applicable only in emergency situations and does not affect the provision of other medical treatments or palliative care. By clarifying these preferences in advance, individuals can help alleviate the emotional burden on loved ones during difficult times and ensure that their healthcare aligns with their values and wishes.

New Jersey Do Not Resuscitate Order Sample

New Jersey Do Not Resuscitate Order

This document serves as a Do Not Resuscitate Order, as permitted under New Jersey state law.

Patient Information:

  • Name: ________________
  • Date of Birth: ________________
  • Address: ________________
  • Medical Record Number: ________________

Ordering Physician Information:

  • Name: ________________
  • License Number: ________________
  • Contact Information: ________________

Declaration:

The above-named patient has expressed a desire not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. This decision has been made voluntarily and is consistent with the patient's health care goals.

Advance Directive Status:

  • Does the patient have an advance directive? Yes / No
  • If yes, please attach a copy of the advance directive.

Signatures:

By signing below, I acknowledge that the individual named above has requested this Do Not Resuscitate Order.

Patient Signature: ________________

Date: ________________

Physician Signature: ________________

Date: ________________

Witness (optional):

  • Name: ________________
  • Signature: ________________
  • Date: ________________

This Do Not Resuscitate Order is effective immediately upon signing and remains in effect unless revoked in writing.

Key takeaways

Filling out and using the New Jersey Do Not Resuscitate (DNR) Order form is a critical step for individuals wishing to communicate their healthcare preferences. Here are some key takeaways to keep in mind:

  1. Understanding the Purpose: A DNR order informs medical personnel that you do not want to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
  2. Eligibility: The DNR order can be completed by adults who are capable of making their own healthcare decisions or by a legally authorized representative.
  3. Completion Process: The form must be filled out accurately, signed, and dated. It is essential to ensure that it reflects your wishes clearly.
  4. Distribution: Once completed, provide copies of the DNR order to your healthcare providers, family members, and anyone involved in your care to ensure your wishes are honored.
  5. Review and Update: Regularly review your DNR order to ensure it still aligns with your healthcare wishes, especially if your health status changes.

Taking these steps can help ensure that your healthcare preferences are respected and understood by those involved in your care.