Get Comfort Care / Do Not Resuscitate ( Dnr ) Order ... - Mass

Filling out the Comfort Care / Do Not Resuscitate (DNR) Order in Massachusetts is an important step for individuals who wish to communicate their preferences regarding resuscitation. This guide provides clear and supportive instructions to help you navigate the process effectively, ensuring that your wishes are documented accurately.

Follow the steps to complete the form accurately and effectively.

1. Locate the form by selecting the ‘Get Form’ button to access the Comfort Care / Do Not Resuscitate (DNR) Order document.
2. Begin filling out the patient's details, including the last name, first name, middle name or initial, date of birth in MM/DD/YYYY format, and gender, ensuring all information is accurate.
3. Continue by entering the patient's residential address, including street, city, state, and ZIP code. Verify that the ZIP code is either 5 or 9 digits long.
4. If applicable, fill in the guardian's or health care agent's last name, first name, and middle name or initial for individuals responsible for the patient's medical decisions.
5. Next, complete the patient, guardian, or health care agent statement section. The individual verifying the DNR must sign and date this section, confirming that the DNR order is current and valid.
6. Move on to the physician, nurse practitioner, or physician assistant verification section. The attending medical professional must sign and date, confirming the validity of the DNR order and noting the effective date of the DNR order verification.
7. Indicate whether the DNR order has an expiration date. If it does, provide that date in the appropriate space.
8. Optionally, complete the bracelet inserts if applicable. The physician or qualified healthcare professional should enter information and sign this section before tearing off the strip and inserting it in the bracelet.
9. Review all entered information for accuracy and completeness before proceeding to the final step.
10. Finally, save your changes, and choose to download, print, or share the completed form as needed to ensure it is readily available.

Take the next step and complete your Comfort Care / DNR Order online today.