Get Comfort Care/do Not Resuscitate ("dnr") Order Verification Form

Filling out the Comfort Care/Do Not Resuscitate ("DNR") Order Verification Form is an important step in ensuring that your healthcare preferences are respected. This guide will walk you through the process of completing this form online in a clear and supportive manner.

Follow the steps to complete your DNR order verification form.

1. Press the ‘Get Form’ button to access the Comfort Care/DNR Order Verification Form. This will open the document in your online editor.
2. Begin by entering the patient's last name, first name, and middle name or initial in the designated fields.
3. Indicate the date of birth of the patient using the MM/DD/YYYY format.
4. Select the gender of the patient by choosing either 'M' for Male or 'F' for Female.
5. Fill out the patient's street or residential address, followed by the city, state, and ZIP code (5 or 9 digits).
6. If applicable, enter the last name and first name of the guardian or health care agent responsible for the patient.
7. In the statement section, select whether you are the patient, guardian, or health care agent by checking the appropriate box, and then sign and date the form.
8. The physician, nurse practitioner, or physician assistant must verify the DNR order by signing the form. Ensure they also include their printed name, address, and telephone number.
9. If the DNR order has an expiration date, indicate it in the specified field. Otherwise, select 'does not' for expiration.
10. Once all fields are completed accurately, save any changes made, and choose to download, print, or share the form as needed.

Make sure to complete your Comfort Care/DNR Order Verification Form online today to ensure your healthcare wishes are documented.