Valid  Do Not Resuscitate Order Template for New York

Valid Do Not Resuscitate Order Template for New York

A Do Not Resuscitate Order (DNR) form in New York allows individuals to refuse life-saving treatments in the event of cardiac or respiratory arrest. This legally binding document ensures that medical personnel respect a patient's wishes regarding resuscitation efforts. Understanding the implications of a DNR is crucial for patients and their families when making end-of-life decisions.

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The New York Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals who wish to express their preferences regarding medical interventions in the event of a life-threatening situation. This form allows patients, or their authorized representatives, to communicate clearly their desire to forgo resuscitation efforts, such as cardiopulmonary resuscitation (CPR), in circumstances where their heart or breathing stops. Designed to respect the autonomy of patients, the DNR Order must be completed and signed by a physician, ensuring that the medical community is aware of the patient's wishes. It is important to note that this form is distinct from other advance directives, as it specifically addresses resuscitation measures. The DNR Order is applicable in various healthcare settings, including hospitals, nursing homes, and even at home, provided that the document is readily available to medical personnel. Additionally, individuals are encouraged to discuss their decision with family members and healthcare providers to ensure that everyone understands the implications of the DNR Order. By taking these steps, patients can ensure that their healthcare preferences are honored, fostering peace of mind during challenging times.

New York Do Not Resuscitate Order Sample

New York Do Not Resuscitate Order

This Do Not Resuscitate Order (DNR) is created pursuant to New York State Public Health Law Section 2994-cc. By signing this document, the individual named below expresses their wishes regarding resuscitation attempts in the event of a medical emergency.

Patient Information

  • Patient's Full Name: ____________________________________________
  • Date of Birth: __________________________________________________
  • Address: ______________________________________________________

Physician Information

  • Physician's Full Name: ___________________________________________
  • Medical License Number: ________________________________________
  • Phone Number: _______________________________________________

Order Details

The patient and their physician hereby agree to the following:

  • The patient does not wish to receive resuscitative measures in the event of cardiac arrest or respiratory failure.
  • This decision reflects the patient's values and preferences regarding end-of-life care.

Acknowledgment

By signing below, the patient asserts that they understand the implications of this order. Other individuals involved in their care have been made aware of these wishes.

Signatures

  • Patient's Signature: ____________________________________________ Date: _______________
  • Physician's Signature: __________________________________________ Date: _______________
  • Witness Signature: ____________________________________________ Date: _______________

This DNR order should be displayed prominently in the patient's medical record and shared with relevant healthcare providers to ensure that this directive is honored.

Key takeaways

Understanding the New York Do Not Resuscitate (DNR) Order form is crucial for ensuring that medical preferences are respected. Here are some key takeaways:

  • Eligibility: The DNR order is applicable to individuals with serious health conditions who wish to refuse resuscitation in case of cardiac or respiratory arrest.
  • Completion: The form must be filled out accurately and signed by the patient or their legal representative.
  • Healthcare Provider's Role: A physician must sign the DNR order for it to be valid. This step confirms that the patient’s wishes are understood and documented.
  • Visibility: Keep the DNR order in a visible location, such as on the refrigerator or in a medical file, so it can be easily accessed by emergency personnel.
  • Revocation: Patients can revoke the DNR order at any time. This can be done verbally or in writing, but it should be communicated clearly to healthcare providers.
  • Communication: It is essential to discuss the DNR order with family members and caregivers to ensure everyone is aware of the patient’s wishes.