Legal Do Not Resuscitate Order Form for the State of New York
Outline
Additional State-specific Do Not Resuscitate Order Forms
Do Not Resuscitate Form - A DNR order keeps your healthcare preferences in focus in critical situations.
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New York Do Not Resuscitate Order Sample
New York Do Not Resuscitate Order (DNR)
This Do Not Resuscitate Order is made pursuant to New York State Public Health Law.
By signing this document, I, [Patient's Full Name], born on [Date of Birth], hereby instruct that in the event of a medical emergency where I am unable to communicate my healthcare wishes, the following orders should be followed:
I do not wish to receive cardiopulmonary resuscitation (CPR) or any other life-sustaining treatment if my heart stops beating or if I stop breathing.
My decision is based on the following considerations:
- [Reason for DNR decision]
- [Patient's wishes]
- [Informed discussions with healthcare providers]
This order should be recognized by all healthcare providers involved in my care.
Patient's Information:
- Patient's Address: [Address]
- Patient's Phone Number: [Phone Number]
Healthcare Proxy (if applicable):
- Name: [Proxy's Full Name]
- Address: [Proxy's Address]
- Phone Number: [Proxy's Phone Number]
Signatures:
- Patient Signature: _______________________ Date: _______________
- Witness Signature: ______________________ Date: _______________
Important Note: This DNR order must be presented in a visible location in the patient's home and included in the patient's medical records.
Instructions on Utilizing New York Do Not Resuscitate Order
Completing the New York Do Not Resuscitate Order form is an important step in expressing your healthcare preferences. After filling out the form, it should be signed and dated by you or your healthcare representative. Make sure to keep copies for your records and share them with your healthcare providers.
- Obtain the New York Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
- Fill in your full name, date of birth, and address in the designated sections at the top of the form.
- Indicate whether you are completing the form for yourself or on behalf of someone else. If you are acting on behalf of someone, include your relationship to that person.
- Review the instructions on the form carefully. Ensure you understand each section before proceeding.
- Sign and date the form at the bottom. If someone else is signing for you, they must also include their signature and date.
- Provide the names and contact information for any witnesses, if required. Check the form for specific witness requirements.
- Make copies of the completed form for your records and to share with your healthcare providers.
- Submit the original form to your healthcare provider or keep it in a safe place where it can be easily accessed in case of an emergency.
Misconceptions
Understanding the New York Do Not Resuscitate (DNR) Order form is crucial for individuals and families making end-of-life decisions. However, several misconceptions can lead to confusion. Here are five common misunderstandings:
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A DNR order means no medical care at all.
This is incorrect. A DNR order specifically instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. Other medical treatments and interventions can still be provided.
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Only terminally ill patients need a DNR.
This is a misconception. While many people with terminal illnesses choose to have a DNR, anyone can request one based on their personal wishes regarding resuscitation, regardless of their health status.
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A DNR order is permanent and cannot be changed.
Actually, a DNR order can be revoked or modified at any time. Patients or their designated representatives can communicate changes to their healthcare providers as needed.
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Healthcare providers must follow a DNR order without question.
While DNR orders are legally binding, healthcare providers are required to assess the situation. If there are concerns about the order's validity or the patient's current condition, they may seek clarification.
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A DNR order is the same as an advance directive.
This is not true. A DNR order specifically addresses resuscitation efforts, while an advance directive encompasses a broader range of healthcare decisions, including preferences for treatment and end-of-life care.
By clarifying these misconceptions, individuals can make informed decisions about their healthcare preferences and communicate them effectively with their loved ones and medical professionals.
Documents used along the form
The New York Do Not Resuscitate (DNR) Order form is an important document for individuals who wish to communicate their preferences regarding resuscitation efforts in medical emergencies. Alongside this form, there are several other documents that can help clarify a person's healthcare wishes. Below is a list of commonly used forms and documents that complement the DNR Order.
- Health Care Proxy: This document allows an individual to appoint someone to make healthcare decisions on their behalf if they become unable to do so.
- Living Will: A living will outlines a person's preferences for medical treatment in situations where they cannot communicate their wishes, particularly regarding end-of-life care.
- Advance Directive: This is a broader term that includes both health care proxies and living wills, detailing a person's healthcare preferences and appointing a decision-maker.
- Physician Orders for Life-Sustaining Treatment (POLST): A POLST form translates a patient's wishes about treatment into actionable medical orders, often used for those with serious illnesses.
- Do Not Intubate (DNI) Order: This order specifies that a patient does not wish to be intubated, which is an important consideration in emergency medical situations.
- Organ Donation Registration: This document allows individuals to express their wishes regarding organ donation after death, ensuring their preferences are honored.
- Non-disclosure Agreement (NDA): A Non-disclosure Agreement is crucial for protecting sensitive information in various relationships, especially in business dealings. Ensure your information remains secure by exploring how to properly fill out this form—click All Washington Forms to learn more.
- Medical History Form: This form provides healthcare providers with essential information about a patient's medical history, which can inform treatment decisions.
- Emergency Contact List: A list of individuals to be contacted in case of a medical emergency, ensuring that loved ones are informed and involved in decision-making.
These documents work together to ensure that an individual's healthcare preferences are respected and communicated effectively. Having a comprehensive set of forms can provide peace of mind and clarity for both the individual and their loved ones during critical moments.