Printable New York Do Not Resuscitate Order Template

Printable New York Do Not Resuscitate Order Template

A New York Do Not Resuscitate Order (DNR) 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 ensure that their preferences for end-of-life care are respected, providing clarity to medical professionals and loved ones alike. Understanding the implications and proper use of this form is essential for anyone considering it as part of their healthcare planning.

Access This Do Not Resuscitate Order Now

The New York Do Not Resuscitate (DNR) Order form is a crucial document for individuals who wish to make their end-of-life care preferences clear. This form allows patients to express their desire not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest or respiratory failure. It is essential for ensuring that medical personnel respect the wishes of patients and their families during critical moments. The DNR form must be completed and signed by a physician, and it requires the patient’s or their legal representative's consent. Once properly executed, the DNR order becomes part of the patient's medical record, guiding healthcare providers in emergency situations. Understanding how to obtain, complete, and implement this form is vital for anyone considering their options for end-of-life care in New York. The form not only provides peace of mind but also fosters open conversations about medical preferences among patients, families, and healthcare professionals.

Dos and Don'ts

When filling out the New York Do Not Resuscitate Order form, it's important to approach the task with care. Here are seven essential dos and don'ts to consider:

  • Do ensure that the form is completed in full, providing all necessary information.
  • Do sign and date the form to validate it.
  • Do discuss your wishes with family members and healthcare providers beforehand.
  • Do keep a copy of the completed form for your records.
  • Don't use vague language; be clear about your wishes regarding resuscitation.
  • Don't forget to review and update the form if your health status changes.
  • Don't assume that verbal instructions will be sufficient; written documentation is crucial.

Key takeaways

When considering a Do Not Resuscitate (DNR) Order in New York, it is important to understand the process and implications. Here are some key takeaways:

  • A DNR Order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if your heart stops or you stop breathing.
  • Only a qualified physician can complete and sign the DNR Order form.
  • The form must be filled out accurately to ensure your wishes are respected. Mistakes can lead to confusion during emergencies.
  • It is essential to discuss your decision with family members and healthcare providers. Communication helps avoid misunderstandings.
  • The DNR Order must be readily available in your medical records and at home, so emergency responders can easily access it.
  • You can revoke or change your DNR Order at any time. Just inform your healthcare provider and ensure they update the records.
  • In New York, a DNR Order is valid statewide, but it must be in the proper format to be recognized.
  • Patients with a DNR Order are still entitled to receive other forms of medical care and treatment.
  • Consider consulting with a lawyer or a healthcare advocate to understand the legal implications of a DNR Order.
  • Keep a copy of the DNR Order in a visible place, such as on the refrigerator or with your medical documents.

Understanding these points can help ensure that your healthcare preferences are honored. Always stay informed and proactive about your medical decisions.

Other Do Not Resuscitate Order State Forms

Example - New York Do Not Resuscitate Order Form

New York Do Not Resuscitate (DNR) Order Template

This Do Not Resuscitate (DNR) Order is valid in the state of New York, according to New York Public Health Law § 2967. This order indicates that the individual does not wish to receive cardiopulmonary resuscitation (CPR) or other resuscitative measures in the event of cardiac arrest.

Patient Information:

  • Name: ________________________________
  • Date of Birth: ________________________
  • Address: ______________________________
  • City, State, Zip: ______________________
  • Phone Number: _________________________

Healthcare Proxy Information:

  • Name: ________________________________
  • Relationship: __________________________
  • Address: ______________________________
  • Phone Number: _________________________

Physician Information:

  • Physician's Name: ______________________
  • Medical License Number: _______________
  • Practice Name: _________________________
  • Address: ______________________________
  • Phone Number: _________________________

This order must be signed and dated by the patient or their healthcare proxy:

Signature of Patient or Healthcare Proxy: ___________________________

Date: ___________________________________

This Do Not Resuscitate order can be revoked at any time, and it is advised that a copy be kept in a visible location within the patient's residence.

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 and anxiety. Below are seven common misconceptions about the DNR Order form, along with clarifications for each.

  1. A DNR Order means that no medical care will be provided. Many believe that a DNR order signifies a refusal of all medical treatment. In reality, it only pertains to resuscitation efforts in the event of cardiac arrest. Other medical interventions can still be administered.
  2. Only terminally ill patients need a DNR Order. Some people think that DNR orders are only for those with terminal illnesses. However, anyone can choose to have a DNR order, regardless of their health status, if they wish to avoid resuscitation.
  3. A DNR Order is permanent and cannot be changed. There is a misconception that once a DNR order is signed, it cannot be altered. In fact, individuals can revoke or modify their DNR order at any time, provided they are competent to do so.
  4. Healthcare providers will not respect a DNR Order. Some fear that medical professionals may ignore a DNR order. However, healthcare providers are legally obligated to honor a valid DNR order, ensuring that patients' wishes are respected.
  5. Having a DNR Order means you are giving up on life. Many believe that requesting a DNR order equates to a desire to end life. This is not the case. A DNR order reflects a personal choice about the type of care one wishes to receive during a medical emergency.
  6. A DNR Order is only applicable in hospitals. It is a common belief that DNR orders are only relevant in hospital settings. In fact, a DNR order is applicable in any healthcare setting, including at home or in nursing facilities.
  7. All DNR Orders are the same across states. Some assume that DNR orders have the same legal standing everywhere in the United States. However, DNR orders can vary by state, and it is essential to understand the specific regulations in New York.

By addressing these misconceptions, individuals can make more informed decisions regarding their healthcare preferences and ensure their wishes are clearly communicated to their loved ones and medical providers.

Similar forms

  • Living Will: This document outlines a person's wishes regarding medical treatment in situations where they cannot communicate. Like a DNR, it specifies the type of care a person wants or does not want.
  • Healthcare Proxy: A healthcare proxy appoints someone to make medical decisions on behalf of another individual. This can include decisions about resuscitation, similar to a DNR.
  • Advance Directive: An advance directive combines a living will and a healthcare proxy. It provides guidance on treatment preferences and designates someone to make decisions, much like a DNR form.
  • Power of Attorney for Healthcare: This document grants someone authority to make healthcare decisions if the individual is unable to do so. It can include directives similar to those found in a DNR.
  • Physician Orders for Life-Sustaining Treatment (POLST): A POLST form translates a patient’s wishes regarding life-sustaining treatments into actionable medical orders, much like a DNR, but often more comprehensive.
  • Do Not Intubate Order: This specific order indicates that a patient should not be intubated in the event of respiratory failure. It is similar to a DNR in that it restricts certain medical interventions.
  • Comfort Care Order: A comfort care order focuses on providing relief from pain and ensuring comfort rather than pursuing curative treatments. It aligns with the intent of a DNR by prioritizing quality of life.
  • Withdrawal of Treatment Order: This document specifies that certain life-sustaining treatments should be stopped. Like a DNR, it emphasizes the patient’s wishes regarding the cessation of aggressive medical interventions.