Fillable Do Not Resuscitate Order Template for the State of New York

Fillable Do Not Resuscitate Order Template for the State of New York

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 healthcare providers respect their decisions about life-sustaining treatments. If you are considering filling out a DNR form, click the button below to get started.

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In the complex landscape of healthcare decisions, the New York Do Not Resuscitate (DNR) Order form stands as a crucial document that empowers individuals to express their wishes regarding end-of-life care. This form is designed for patients who, in the event of a cardiac arrest or respiratory failure, prefer not to receive resuscitation efforts, such as chest compressions or intubation. It is essential for patients to understand that this decision is deeply personal and should be made with careful consideration and, ideally, in consultation with healthcare providers and loved ones. The DNR Order must be completed and signed by a qualified physician, ensuring that it reflects the patient's desires accurately. Furthermore, the form includes specific sections for patient identification, the attending physician's information, and the signatures of witnesses, all of which contribute to its validity. By clearly documenting a patient's preferences, the DNR Order helps to alleviate confusion and stress for family members and healthcare professionals during critical moments. Understanding the implications of this form can provide peace of mind and ensure that one's values and wishes are honored when it matters most.

Your Questions, Answered

  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 arrest or respiratory failure. It indicates that medical personnel should 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 competent to make their own healthcare decisions. If the patient is unable to make decisions, a legally authorized representative, such as a family member or healthcare proxy, can request it on their behalf.

  3. How is a DNR Order created in New York?

    A DNR Order must be documented on a specific form, which is available through healthcare providers or online. The form must be signed by the patient (or their representative) and a physician. It is important to ensure that the form is filled out completely and accurately.

  4. What should I do with the DNR Order once it is completed?

    Once the DNR Order is completed and signed, it should be kept in a visible place, such as on the refrigerator or with other important medical documents. Inform family members and caregivers about its location to ensure it can be easily accessed in an emergency.

  5. Can a DNR Order be revoked?

    Yes, a DNR Order can be revoked at any time. The patient or their representative can verbally communicate the revocation to healthcare providers, or they can destroy the original form. It is essential to inform all relevant parties about the change.

  6. What happens if a DNR Order is not followed?

    If a DNR Order is not followed, it may lead to unwanted medical interventions. Healthcare providers are legally obligated to respect the wishes outlined in the DNR. If a violation occurs, it can result in legal consequences for the medical staff involved.

  7. Will a DNR Order affect other medical treatments?

    A DNR Order specifically addresses resuscitation efforts and does not affect other medical treatments. Patients can still receive other forms of care, such as pain management, comfort measures, and medications, as needed.

  8. Is a DNR Order the same as a Living Will?

    No, a DNR Order is not the same as a Living Will. A Living Will outlines a person's wishes regarding medical treatment in various situations, while a DNR Order specifically addresses resuscitation efforts. Both documents can be part of a comprehensive advance care plan.

  9. Where can I get more information about DNR Orders?

    For more information about DNR Orders in New York, you can consult with healthcare providers, legal professionals, or organizations specializing in advance care planning. Resources are also available through state health departments and advocacy groups.

Detailed Guide for Using New York Do Not Resuscitate Order

Completing the New York Do Not Resuscitate Order form involves several important steps. This form allows individuals to express their wishes regarding resuscitation in a clear and legally recognized manner. After filling out the form, it should be shared with healthcare providers and kept in an accessible location.

  1. Obtain the New York Do Not Resuscitate Order form. This can typically be found online or through healthcare facilities.
  2. Begin by filling in your personal information at the top of the form. Include your full name, date of birth, and address.
  3. Next, indicate whether you are the patient or the legal representative of the patient. If you are a representative, provide your relationship to the patient.
  4. Specify the patient's medical condition. This may involve a brief description of the patient's health status or diagnosis.
  5. Clearly state your wishes regarding resuscitation. There may be specific checkboxes or sections to indicate your preferences.
  6. Sign and date the form. Ensure that the signature is yours or that of the legal representative, if applicable.
  7. Have the form witnessed. This may require one or two witnesses, depending on the specific requirements outlined on the form.
  8. Make copies of the completed form for your records and to share with healthcare providers.
  9. Store the original form in a safe yet accessible location, such as with your medical records or in a designated folder.

Documents used along the form

When considering end-of-life care preferences, the New York Do Not Resuscitate (DNR) Order form is a crucial document. However, it is often accompanied by several other forms and documents that help clarify a person’s medical wishes and legal rights. Below are five important documents that may be used alongside the DNR Order.

  • Health Care Proxy: This document allows an individual to appoint someone they trust to make medical decisions on their behalf if they become unable to do so. It ensures that a person’s healthcare preferences are honored, even when they cannot communicate them.
  • Living Will: A living will is a written statement that outlines a person's wishes regarding medical treatment in situations where they are terminally ill or incapacitated. It provides guidance to healthcare providers and loved ones about the types of treatments one does or does not want.
  • Order of Life-Sustaining Treatment (OLST): This form is similar to a DNR but goes further by detailing a person's preferences for a variety of life-sustaining treatments, such as intubation or feeding tubes. It serves as a comprehensive guide for emergency medical personnel.
  • Advance Directive: An advance directive is a broader term that encompasses both health care proxies and living wills. It allows individuals to express their healthcare preferences and appoint a decision-maker, ensuring their wishes are respected in critical situations.
  • Do Not Intubate (DNI) Order: This specific order complements the DNR by indicating that a patient does not wish to be intubated in the event of respiratory failure. It helps clarify the scope of resuscitation efforts that should or should not be undertaken.

Understanding these documents can empower individuals to make informed decisions about their medical care and ensure that their wishes are respected. Each form plays a vital role in creating a comprehensive plan for end-of-life care, providing peace of mind for both patients and their families.

Similar forms

The New York Do Not Resuscitate (DNR) Order form is similar to an Advance Healthcare Directive. Both documents allow individuals to express their healthcare preferences in advance, particularly regarding life-sustaining treatments. An Advance Healthcare Directive encompasses a broader range of medical decisions, including appointing a healthcare proxy, while a DNR specifically addresses the desire to forgo resuscitation in case of cardiac or respiratory arrest.

Another similar document is the Physician Orders for Life-Sustaining Treatment (POLST). The POLST form translates a patient's wishes regarding life-sustaining treatments into actionable medical orders. Like the DNR, it is intended for individuals with serious illnesses or those nearing the end of life. However, POLST covers a wider array of treatment options, allowing for more detailed instructions beyond just resuscitation preferences.

The Living Will is also comparable to the DNR Order. A Living Will outlines a person's wishes about medical treatment in situations where they cannot communicate their preferences. While a DNR focuses specifically on resuscitation efforts, a Living Will may address other critical medical interventions, such as artificial nutrition or hydration, providing a broader scope of end-of-life decisions.

The Healthcare Proxy form shares similarities with the DNR Order as well. This document allows individuals to designate someone to make medical decisions on their behalf if they become unable to do so. While the DNR specifies wishes about resuscitation, a Healthcare Proxy can ensure that those wishes, including DNR preferences, are honored in various medical situations.

Another related document is the Medical Power of Attorney. This legal document grants a designated person the authority to make healthcare decisions for someone else. Like the Healthcare Proxy, it can include instructions about resuscitation and other life-sustaining measures, ensuring that the individual's wishes are respected when they cannot voice them themselves.

The Comfort Care Order is similar in that it focuses on providing comfort rather than aggressive medical treatment. This document emphasizes palliative care and pain management, aligning with the intent of a DNR to avoid unnecessary interventions. Both documents prioritize the quality of life over prolonging life through invasive measures.

Another document to consider is the Do Not Intubate (DNI) Order. While a DNR specifically addresses the refusal of resuscitation efforts, a DNI focuses on the refusal of intubation and mechanical ventilation. Both documents reflect a patient’s desire to avoid certain life-sustaining treatments, but they target different aspects of emergency medical care.

The Durable Power of Attorney for Health Care is also related. This document allows individuals to appoint someone to make healthcare decisions, similar to a Healthcare Proxy. While a DNR outlines specific medical preferences, the Durable Power of Attorney can encompass a wider range of decisions, including those related to resuscitation and end-of-life care.

Lastly, the End-of-Life Care Plan is akin to the DNR Order. This comprehensive document outlines a person's wishes regarding all aspects of end-of-life care, including resuscitation preferences. While the DNR focuses solely on resuscitation, the End-of-Life Care Plan can address various treatment options, ensuring that the individual's overall wishes are considered and respected during critical moments.

Document Overview

Fact Name Description
Purpose The New York Do Not Resuscitate Order (DNR) form allows individuals to refuse resuscitation in the event of cardiac or respiratory arrest.
Legal Authority This form is governed by New York Public Health Law, specifically Article 29-B, which outlines the rights of patients regarding medical treatment.
Eligibility Any adult can complete a DNR order, but it must be signed by a physician and the patient or their legal representative to be valid.
Location The DNR form should be kept in a prominent place, such as on the refrigerator or with other important medical documents, to ensure it is easily accessible in an emergency.