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New York Do Not Resuscitate Order (DNR)
This Do Not Resuscitate (DNR) Order is made in accordance with New York State laws regarding healthcare directives. This document indicates that the undersigned does not wish to receive cardiopulmonary resuscitation (CPR) or certain life-sustaining treatments in the event of cardiac arrest or respiratory failure.
Please fill out the following information accurately.
- Patient's Full Name: ____________________________
- Date of Birth: ____________________________
- Address: ____________________________
- Phone Number: ____________________________
- Health Care Proxy Name: ____________________________
- Health Care Proxy Phone Number: ____________________________
By signing below, I acknowledge that I understand the implications of this DNR Order:
Patient Signature: ____________________________
Date: ____________________________
Witness Signature: ____________________________
Date: ____________________________
Please ensure this document is accessible in your medical records and shared with your healthcare providers.
Form Data
| Fact Name | Description |
|---|---|
| Definition | A Do Not Resuscitate (DNR) Order in New York is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. |
| Governing Law | The New York State Public Health Law, specifically Section 2994-a, governs the use and implementation of DNR orders. |
| Eligibility | Any adult with the capacity to make medical decisions can request a DNR order, as can a legally authorized representative for those who lack capacity. |
| Form Requirements | The DNR order must be signed by a physician and include specific information such as the patient's name, date of birth, and the physician's contact information. |
| Revocation | A DNR order can be revoked at any time by the patient or their representative. This can be done verbally or by destroying the DNR form. |
| Emergency Medical Services | Emergency medical services (EMS) personnel must honor a valid DNR order. They are trained to recognize and respect these orders during emergencies. |
New York Do Not Resuscitate Order - Usage Guidelines
Filling out the New York Do Not Resuscitate Order form is a critical step in ensuring your healthcare preferences are respected in emergency situations. It is essential to complete this form accurately to avoid any confusion regarding your wishes.
- Obtain the New York Do Not Resuscitate Order form. This can typically be found online or through your healthcare provider.
- Read the instructions carefully before starting to fill out the form.
- Provide your full name, date of birth, and address in the designated sections.
- Indicate whether you have a healthcare proxy. If yes, include the proxy's name and contact information.
- Sign and date the form. Ensure that your signature is clear and legible.
- Have your physician complete the required section, which may include their signature and date.
- Make copies of the completed form for your records and for your healthcare proxy, if applicable.
- Distribute copies to your healthcare providers and ensure they are aware of your wishes.
Once you have completed the form, keep it in a safe yet accessible location. It is advisable to discuss your decision with family members and your healthcare team to ensure everyone understands your wishes.
Some Other Do Not Resuscitate Order State Templates
Dnr Form Pennsylvania - Reflects individual values about quality of life versus prolongation of life.
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What Does Dnr Mean - A DNR can be revoked at any time by the patient, should their preferences change.
Dos and Don'ts
When filling out the New York Do Not Resuscitate (DNR) Order form, it’s important to approach the process with care. Here’s a list of what you should and shouldn’t do:
- Do ensure that you understand the implications of a DNR order before completing the form.
- Do consult with your healthcare provider to discuss your wishes and any medical conditions.
- Do fill out the form completely and accurately to avoid any confusion later.
- Do sign and date the form as required, ensuring that it is legally valid.
- Don't rush through the process; take your time to consider your decisions carefully.
- Don't forget to share copies of the completed form with your family and healthcare providers.
By following these guidelines, you can help ensure that your wishes are respected and understood. It’s a significant step in planning for your healthcare preferences.
Common mistakes
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Failing to provide accurate personal information.
Individuals often overlook the importance of including complete and correct details such as their name, date of birth, and address. Missing or incorrect information can lead to confusion and complications during critical situations.
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Not obtaining the necessary signatures.
A common mistake is neglecting to secure the required signatures from both the patient and the physician. Without these signatures, the order may not be considered valid, which could result in unwanted medical interventions.
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Using outdated forms.
Some individuals may fill out an older version of the Do Not Resuscitate Order form. It is essential to ensure that the most current version is used to avoid any legal issues or misunderstandings regarding the patient's wishes.
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Not discussing the order with family members.
Failing to communicate the decision to family members can lead to distress and confusion at a critical moment. Open conversations about the order can help ensure that everyone understands and respects the patient's wishes.