Get Sd Ems Cariopulmonary Resuscitation Directive Patient Information 2020-2025

Completing the SD EMS Cariopulmonary Resuscitation Directive Patient Information form is essential for ensuring that your healthcare preferences are respected. This guide will provide clear instructions on how to accurately fill out the form online while maintaining your comfort and dignity.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering your full name in the 'Patient Name' field. Ensure it is spelled correctly, as this will be used for identification purposes.
3. Next, fill in your address, including city, state, and zip code. This information is necessary for your medical records.
4. Enter your date of birth (D.O.B) to confirm your identity and age.
5. Select your gender by marking 'M' for male, 'F' for female, or leave it blank if you prefer not to disclose.
6. Provide details such as your eye color and hair color. This information can assist in your identification.
7. Describe your race or ethnic background in the designated field. This helps in understanding demographic needs.
8. If applicable, indicate the name of your hospice program.
9. Fill in the name, address, and phone number of your attending physician, physician assistant, or nurse practitioner. This contact information is crucial for your healthcare providers.
10. Sign the designated area to confirm that you are directing EMS personnel and healthcare providers to not resuscitate you, acknowledging your COMFORT ONE status.
11. Have your physician, physician assistant, or nurse practitioner sign and date the form to validate the directive.
12. Review all entries for accuracy before saving your changes. Once confirmed, you can download, print, or share the form as needed.

Complete your SD EMS Cariopulmonary Resuscitation Directive Patient Information form online today to ensure your healthcare wishes are honored.