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The New York Do Not Resuscitate (DNR) Order form is a crucial document for individuals who wish to express their preferences regarding medical treatment in the event of a life-threatening situation. This form allows patients to indicate that they do not want to receive cardiopulmonary resuscitation (CPR) or other life-saving measures if their heart stops or they stop breathing. It is important to understand that the DNR Order is not a directive to withhold all medical treatment; rather, it specifically addresses resuscitation efforts. The form must be completed and signed by a physician and the patient, or their legal representative, ensuring that the wishes of the individual are respected. Additionally, the DNR Order must be readily available to medical personnel in emergencies, often carried on the patient or in their medical records. Understanding the implications of this form is essential for anyone considering it, as it provides a way to maintain control over one’s healthcare decisions during critical moments.
PDF Specifics
| Fact Name | Description |
|---|---|
| Definition | A Do Not Resuscitate (DNR) order is a legal document that instructs medical personnel not to perform CPR if a patient's heart stops beating or they stop breathing. |
| Governing Law | The New York DNR order is governed by the New York Public Health Law, specifically Article 29-B. |
| Eligibility | Any adult with the capacity to make healthcare decisions can complete a DNR order. This includes individuals who are terminally ill or have a serious medical condition. |
| Form Requirements | The DNR order must be signed by the patient or their healthcare proxy and a physician to be valid. |
| Location | The DNR order should be kept in a place where it can be easily accessed by medical personnel, such as at home or in a medical file. |
| Revocation | A DNR order can be revoked at any time by the patient or their healthcare proxy, verbally or in writing. |
| Emergency Response | Emergency medical services (EMS) must honor a valid DNR order. If the order is not available at the scene, EMS will provide resuscitation until the order is confirmed. |
How to Write New York Do Not Resuscitate Order
Filling out the New York Do Not Resuscitate Order form is an important step for individuals wishing to communicate their medical preferences. This document ensures that your wishes regarding resuscitation are clearly stated and respected by healthcare providers. Follow these steps carefully to complete the form accurately.
- Obtain the New York Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
- Begin by entering your full name in the designated section at the top of the form.
- Provide your date of birth. This information helps to confirm your identity.
- Next, fill in your address. Include the street, city, state, and zip code.
- Designate a healthcare proxy if you have one. This person will make medical decisions on your behalf if you are unable to do so.
- Sign the form. Your signature indicates that you understand the implications of the order.
- Date the form. This is crucial as it shows when the order was completed.
- Have a witness sign the form. This witness should not be your healthcare proxy or a relative.
- Keep a copy of the completed form for your records. Share copies with your healthcare provider and your designated proxy.
Once you have filled out the form, it is essential to communicate your wishes to your healthcare team and loved ones. Ensure they understand your preferences so that your choices are honored in any medical situation.
New York Do Not Resuscitate Order Example
New York Do Not Resuscitate Order
This Do Not Resuscitate (DNR) Order is intended for use in the state of New York, following the New York State Public Health Law. It outlines your wishes regarding resuscitation efforts in the event of a medical emergency. It is important to discuss this document with your healthcare provider and loved ones.
Patient Information:
- Full Name: ___________________________
- Date of Birth: ________________________
- Address: ______________________________
- City, State, Zip: _____________________
Health Care Proxy Information:
- Full Name: ___________________________
- Relationship to Patient: _______________
- Phone Number: ________________________
Statement of Wishes:
I, the undersigned, understand that the purpose of this order is to express my wishes regarding resuscitation attempts in the event of a cardiac or respiratory arrest. I do not wish to receive cardiopulmonary resuscitation (CPR) or other life-saving measures if my heart stops or I stop breathing.
Signature:
- Patient Signature: _____________________
- Date: ________________________________
Witness Information:
- Witness Name: ________________________
- Witness Signature: _____________________
- Date: ________________________________
By completing this document, you affirm that you are making informed choices about your healthcare. Consider discussing your preferences with your healthcare team to ensure that your wishes are respected.
Other Do Not Resuscitate Order State Forms
Illinois Do Not Resuscitate - Families should discuss the implications of a DNR order to ensure everyone is on the same page.
Additionally, for those looking to simplify the process, the Arizona PDF Forms website offers a convenient and easy-to-use template that ensures all necessary details are captured accurately, further enhancing the clarity and legality of the transaction.
What Does Dnr Mean - A DNR is used to prevent unnecessary suffering in terminally ill patients.