Blank Do Not Resuscitate Order Document for New York State Open Editor

Blank Do Not Resuscitate Order Document for New York State

A New York Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. By completing this form, patients can communicate their desire to forgo life-saving measures, ensuring that their preferences are respected by healthcare providers. Understanding the implications and process of this form is crucial for anyone considering it for themselves or a loved one.

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What to Know About This Form

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

    A Do Not Resuscitate Order is a legal document that allows a person to refuse resuscitation efforts in the event of a cardiac or respiratory arrest. This means that if the heart stops beating or breathing ceases, medical personnel will not perform CPR or other life-saving measures.

  2. Who can request a DNR Order in New York?

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

  3. How do I obtain a DNR Order form?

    You can obtain a DNR Order form from a healthcare provider, hospital, or through the New York State Department of Health's website. It is essential to ensure that the form is filled out correctly to be valid.

  4. What information is required on the DNR Order form?

    The DNR Order form requires the patient's name, date of birth, and the signature of the patient or their authorized representative. Additionally, the form must be signed by a physician to be legally binding.

  5. Is a DNR Order valid outside of a hospital setting?

    Yes, a DNR Order is valid in both hospital and non-hospital settings in New York. However, it is crucial to ensure that the form is readily accessible to emergency medical personnel in case of an emergency.

  6. Can I change or revoke my DNR Order?

    Yes, you can change or revoke your DNR Order at any time. To do so, you should inform your healthcare provider and ensure that any new documentation reflects your current wishes.

  7. What happens if I don’t have a DNR Order?

    If you do not have a DNR Order and experience a cardiac or respiratory arrest, medical personnel will perform resuscitation efforts unless instructed otherwise. It is important to communicate your wishes to your healthcare provider and family members.

  8. How does a DNR Order affect other medical treatments?

    A DNR Order specifically pertains to resuscitation efforts. It does not affect other medical treatments or interventions. Patients can still receive all other necessary medical care, including pain management and comfort measures.

  9. Where should I keep my DNR Order?

    Keep your DNR Order in a visible location, such as on your refrigerator or with your other important medical documents. Inform your family members and healthcare providers about its location to ensure it can be accessed quickly in an emergency.

Misconceptions

Understanding the New York Do Not Resuscitate (DNR) Order form is crucial for patients and their families. However, several misconceptions can lead to confusion. Here are eight common misconceptions explained:

  1. A DNR means no medical treatment at all. Many believe that a DNR order implies a complete withdrawal of all medical care. In reality, a DNR specifically addresses resuscitation efforts during cardiac or respiratory arrest, not other forms of treatment.
  2. Only terminally ill patients need a DNR. Some think that only those diagnosed with terminal illnesses should consider a DNR. However, anyone can request a DNR, regardless of their health status, if they wish to avoid resuscitation in specific situations.
  3. A DNR is permanent and cannot be changed. There is a misconception that once a DNR is signed, it cannot be altered. In fact, individuals can revoke or modify their DNR order at any time, as long as they are mentally competent to do so.
  4. Emergency personnel will ignore a DNR. Some fear that emergency responders will not respect a DNR order. In New York, emergency personnel are trained to recognize and honor valid DNR orders, ensuring that a patient's wishes are followed.
  5. Only doctors can initiate a DNR. While healthcare providers play a significant role in discussing and completing a DNR, patients and their families can also initiate conversations about their preferences regarding resuscitation.
  6. A DNR is the same as a Living Will. Many confuse a DNR with a Living Will. A DNR specifically addresses resuscitation efforts, while a Living Will outlines broader healthcare preferences, including end-of-life care decisions.
  7. A DNR is only for older adults. There is a belief that DNR orders are primarily for the elderly. However, individuals of any age can choose to have a DNR, particularly if they have specific health concerns or preferences regarding resuscitation.
  8. A DNR order must be signed by a lawyer. Some think that legal representation is necessary to complete a DNR. In New York, a DNR form can be filled out and signed by the patient and their healthcare provider without needing a lawyer.

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

PDF Form Attributes

Fact Name Description
Purpose The New York Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation in case of a medical emergency.
Governing Law The DNR Order in New York is governed by Public Health Law § 2967 and § 2994-d.
Eligibility Any adult who is competent can complete a DNR Order, and it must be signed by a physician.
Validity The DNR Order remains valid across all healthcare settings in New York once properly completed and signed.

Common mistakes

  1. Not including the patient's full name: It is essential to provide the complete legal name of the patient. Omitting this detail can lead to confusion and complications in emergency situations.

  2. Failing to sign the form: A signature is crucial. Without it, the order may not be recognized by medical personnel, rendering it ineffective.

  3. Not updating the form: Life circumstances change. If there are any changes in the patient's health status or wishes, the form should be updated accordingly to reflect those changes.

  4. Ignoring the witness requirement: The form typically requires a witness signature. Failing to have a witness can invalidate the order and cause issues during emergencies.

  5. Not discussing the decision with family: It is important to communicate the decision with family members. This ensures everyone is on the same page and can help prevent misunderstandings during critical moments.

Preview - New York Do Not Resuscitate Order Form

New York Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is a legal document that communicates your wishes regarding resuscitation efforts in the event of cardiac or respiratory arrest, in accordance with New York state laws.

Patient Information:

  • Name: _______________________________
  • Date of Birth: _______________________
  • Address: ____________________________
  • Phone Number: _______________________

Authorized Health Care Representative (if applicable):

  • Name: _______________________________
  • Relationship to Patient: ______________
  • Phone Number: _______________________

Patient's Wishes:

I, the undersigned, direct that, in the event of my cardiac or respiratory arrest, the following treatment should not be initiated:

Do Not Resuscitate: Yes ___ No ___

This DNR order is effective immediately and will remain valid until it is revoked by the patient or a new DNR is issued. It should be kept in a prominent place in my medical records and shared with all healthcare providers involved in my care.

Signature of Patient or Authorized Representative:

  • Signature: ____________________________
  • Date: _________________________________

Witness Information:

  • Name: _______________________________
  • Signature: ____________________________
  • Date: _________________________________

This document is executed as a legally binding directive in accordance with New York state law. Please ensure it is provided to medical personnel and stored in my medical records for future reference.

Other State-specific Do Not Resuscitate Order Templates