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In New York, the 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 cardiac arrest or respiratory failure. This form allows patients to indicate that they do not want to receive cardiopulmonary resuscitation (CPR) or other life-saving measures. It is important for individuals to understand that completing a DNR form is a personal decision, often made in consultation with healthcare providers, family members, or legal representatives. The DNR Order must be signed by a physician and can be kept in a visible location, such as on a refrigerator or with other important medical documents, to ensure that emergency responders are aware of the patient's wishes. Additionally, the form should be updated regularly to reflect any changes in a person's health status or preferences. Understanding the implications of a DNR Order is essential, as it can significantly impact end-of-life care and the overall approach to treatment. By being informed about this form, individuals can make empowered choices that align with their values and beliefs about medical care in critical situations.

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Similar forms

  • Living Will: A living will outlines an individual's preferences for medical treatment in situations where they are unable to communicate. Like a DNR, it focuses on end-of-life care and can specify the types of interventions a person does or does not want.
  • Durable Power of Attorney for Healthcare: This document allows a person to designate someone else to make healthcare decisions on their behalf if they become incapacitated. It complements a DNR by ensuring that someone trusted can advocate for the individual's wishes.
  • Physician Orders for Life-Sustaining Treatment (POLST): A POLST form is a medical order that outlines a patient's preferences for treatment in emergencies. Similar to a DNR, it provides clear guidance to healthcare providers about the patient's wishes regarding resuscitation and other life-sustaining measures.
  • Motor Vehicle Bill of Sale: The Ohio Motor Vehicle Bill of Sale form is a critical document that records the essential details of the sale of a vehicle between two parties in Ohio. It serves as a proof of transaction and establishes the transfer of ownership from the seller to the buyer. For more information, you can visit All Ohio Forms.
  • Advance Healthcare Directive: This comprehensive document combines elements of a living will and a durable power of attorney. It allows individuals to express their healthcare preferences and appoint a representative, ensuring that their wishes are honored in various medical situations.
  • Do Not Intubate (DNI) Order: A DNI order specifically indicates that a patient does not want to be intubated in the event of respiratory failure. While a DNR focuses on cardiac arrest, a DNI directly addresses breathing support, making both documents essential for end-of-life care planning.

Document Example

New York Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is created in accordance with New York State laws regarding advance directives and the rights of patients to make choices about their medical treatment.

Patient Information

  • Patient Name: ____________________________
  • Date of Birth: ____________________________
  • Address: ________________________________
  • Phone Number: __________________________

Physician Information

  • Physician Name: ____________________________
  • Medical License Number: ____________________
  • Address: ________________________________
  • Phone Number: __________________________

Order Statement

I, the undersigned patient, hereby declare that I do not wish to receive cardiopulmonary resuscitation (CPR) or any other life-sustaining treatment in the event of cardiac or respiratory arrest.

Signatures

This order is effective upon signature below.

  1. Patient Signature: ____________________________
  2. Date: ____________________________
  3. Physician Signature: ____________________________
  4. Date: ____________________________

Witness Statements

Two witnesses must sign this order for it to be valid.

  1. Witness 1 Name: ____________________________
  2. Witness 1 Signature: ____________________________
  3. Date: ____________________________
  4. Witness 2 Name: ____________________________
  5. Witness 2 Signature: ____________________________
  6. Date: ____________________________

This Do Not Resuscitate Order is a critical document that reflects the patient's wishes and should be displayed prominently in medical settings to ensure that healthcare providers adhere to the patient's decisions.

PDF Form Specs

Fact Name Details
Definition A Do Not Resuscitate (DNR) Order is a legal document that indicates a person's wishes regarding resuscitation efforts in case of cardiac or respiratory arrest.
Governing Law The New York Do Not Resuscitate Order is governed by New York Public Health Law, Article 29-B.
Eligibility Any individual aged 18 or older can create a DNR order, provided they are capable of making informed medical decisions.
Form Requirements The DNR order must be signed by the patient or their legal representative and a physician to be valid.
Emergency Services Emergency medical personnel are required to honor a valid DNR order presented at the scene of a medical emergency.
Revocation A DNR order can be revoked at any time by the patient or their legal representative, either verbally or in writing.
Documentation It is recommended that a copy of the DNR order be kept in the patient’s medical records and with their family members.
Not a Living Will A DNR order specifically addresses resuscitation efforts, while a living will covers broader medical treatment preferences.
Public Awareness New York State provides resources and information to help individuals understand DNR orders and their implications.

Crucial Questions on This Form

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

A Do Not Resuscitate Order (DNR) is a medical order that tells healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops beating or if they stop breathing. In New York, a DNR order is legally recognized and must be followed by medical personnel.

Who can request a DNR order?

A DNR order can be requested by a patient who is capable of making their own healthcare decisions. If a patient is unable to communicate their wishes, a legally authorized representative, such as a family member or a healthcare proxy, can make the request on their behalf.

How do I obtain a DNR order in New York?

To obtain a DNR order, follow these steps:

  1. Consult with your healthcare provider about your wishes regarding resuscitation.
  2. Complete the New York State Do Not Resuscitate Order form. This form can be obtained from hospitals, healthcare providers, or online.
  3. Ensure that the form is signed by both the patient and a physician.
  4. Keep copies of the signed DNR order in accessible places, such as with your medical records and at home.

Where should I keep my DNR order?

It's important to keep your DNR order in a place where it can be easily found in an emergency. Consider these options:

  • Place a copy in your medical records at your healthcare provider's office.
  • Keep a copy at home, perhaps on your refrigerator or near your phone.
  • Provide copies to family members and close friends who may need to share your wishes in an emergency.

Can I change or revoke my DNR order?

Yes, you can change or revoke your DNR order at any time. To do this, simply destroy the existing order and inform your healthcare provider of your new wishes. If you decide to create a new DNR order, make sure it is properly signed and distributed as needed.

What should I do if I change my mind about resuscitation?

If you change your mind about your DNR order, it’s crucial to communicate your new wishes to your healthcare provider. You can then revoke the existing order and create a new one if desired. Always ensure that your family members and caregivers are aware of your current wishes to avoid confusion in an emergency.

Documents used along the form

The New York Do Not Resuscitate (DNR) Order form is a crucial document for individuals who wish to communicate their preferences regarding resuscitation efforts in medical emergencies. However, several other forms and documents often accompany this order to ensure comprehensive medical care planning. Below is a list of these important documents, each serving a specific purpose in the realm of healthcare decisions.

  • Health Care Proxy: This document allows an individual to appoint someone they trust to make healthcare decisions on their behalf if they become unable to do so. It ensures that a person's wishes are respected even when they cannot communicate them directly.
  • Living Will: A living will outlines an individual's preferences regarding medical treatment in situations where they are terminally ill or permanently unconscious. It provides guidance to healthcare providers and family members about the types of life-sustaining treatments the individual does or does not want.
  • Advance Directive: This is a broader term that encompasses both the health care proxy and living will. An advance directive provides a comprehensive view of a person's healthcare preferences and decisions regarding end-of-life care.
  • POLST (Physician Orders for Life-Sustaining Treatment): A POLST form translates a patient’s wishes regarding life-sustaining treatments into medical orders. It is typically used for patients with serious illnesses and is recognized by healthcare providers across various settings.
  • Do Not Hospitalize Order: This order indicates that a patient does not wish to be admitted to a hospital for treatment. It is particularly relevant for individuals in long-term care facilities who prefer to receive care in place.
  • Tractor Bill of Sale: This form is essential for documenting the transfer of ownership of a tractor in Georgia, ensuring all transaction details are recorded accurately. For more information, visit georgiapdf.com/tractor-bill-of-sale.
  • Organ Donation Registration: This document expresses an individual's wishes regarding organ donation after death. It can be registered with the state and is crucial for ensuring that a person's wishes are honored.
  • Medical Power of Attorney: Similar to a health care proxy, this document grants a designated person the authority to make medical decisions on behalf of another individual. It is essential for ensuring that someone trusted can advocate for the patient’s healthcare needs.
  • Patient Advocate Designation: This form allows an individual to name a patient advocate who can help navigate the healthcare system and make decisions when needed. This advocate can assist in ensuring that the patient’s wishes are communicated effectively.
  • Do Not Resuscitate Bracelet: A physical bracelet that indicates a person's DNR status. It serves as a quick reference for medical personnel in emergencies, ensuring that the individual’s wishes are known without delay.
  • Emergency Medical Services (EMS) Information: This document provides vital information for EMS personnel about a patient’s medical history and preferences. It can help guide treatment decisions in emergency situations.

Understanding these documents and their roles in healthcare planning is essential for individuals and families. Each form contributes to a clearer communication of medical preferences, ultimately ensuring that personal values and wishes are honored during critical moments.

Misconceptions

Understanding the New York Do Not Resuscitate (DNR) Order form is essential for making informed healthcare decisions. However, several misconceptions can lead to confusion. Here are eight common misconceptions and their clarifications:

  1. A DNR means no medical care at all. Many people believe that a DNR order implies a complete refusal of all medical treatment. In reality, a DNR only applies to resuscitation efforts, such as CPR. Other medical treatments may still be provided.
  2. Only terminally ill patients need a DNR. While DNR orders are often associated with terminal illnesses, they can be appropriate for anyone who wishes to avoid resuscitation in specific situations, regardless of their overall health status.
  3. A DNR is only valid in hospitals. This misconception suggests that DNR orders are only recognized in hospital settings. However, a properly executed DNR can be honored in various locations, including at home or in nursing facilities.
  4. You cannot change your mind about a DNR. Some individuals think that once a DNR is established, it cannot be revoked. In fact, individuals can change or cancel their DNR orders at any time, provided they communicate their wishes clearly.
  5. A DNR order is the same as a living will. Many people confuse a DNR with a living will. While both documents relate to end-of-life decisions, a living will addresses a broader range of medical treatments, whereas a DNR specifically focuses on resuscitation efforts.
  6. All healthcare providers will honor a DNR. There is a belief that all medical professionals will automatically follow a DNR order. While most will, it is crucial to ensure that the order is properly documented and communicated to all relevant parties.
  7. You need a lawyer to create a DNR. Some assume that legal assistance is necessary to complete a DNR form. In New York, individuals can fill out the DNR order without legal help, as long as they follow the required guidelines.
  8. A DNR order is permanent. Many believe that once a DNR is in place, it remains forever. However, DNR orders can be temporary and may need to be reviewed or renewed based on changes in a patient’s health status or preferences.

Clarifying these misconceptions can help individuals make informed decisions regarding their healthcare preferences and ensure that their wishes are respected.