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Get Ma Comfort Care/dnr Order Verification Form 2006-2026
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How to fill out the MA Comfort Care/DNR Order Verification Form online
Filling out the MA Comfort Care/DNR Order Verification Form is essential for ensuring that a person's wishes regarding resuscitation are respected in emergency situations. This guide will provide you with detailed, step-by-step instructions on how to complete this important form online.
Follow the steps to accurately complete the MA Comfort Care/DNR Order Verification Form.
- Click ‘Get Form’ button to access the form and open it for editing.
- Begin by entering the patient’s last name, first name, and middle name or initial, as applicable.
- Fill in the patient's date of birth using the MM/DD/YYYY format.
- Select the patient’s gender by marking either 'M' for male or 'F' for female.
- Provide the patient’s street or residential address, including the city, state, and ZIP code (5 or 9 digits).
- If applicable, enter the last name, first name, and middle name or initial of the guardian or health care agent.
- The patient, guardian, or health care agent must sign and date the statement verifying the current and valid Do Not Resuscitate order.
- The attending physician, nurse practitioner, or physician assistant must verify the DNR order by signing and dating in the designated section, indicating whether the order has an expiration date.
- Ensure that the physician, nurse practitioner, or physician assistant also fills in their printed name, address, and telephone number.
- If necessary, provide the effective date of the DNR order verification and the expiration date, if any.
- Once all fields are completed, save changes to the form, download a copy, print it, or share it as needed.
Start filling out the MA Comfort Care/DNR Order Verification Form online today to ensure your health care preferences are honored.
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A Do Not Resuscitate order does not mean do not treat if a condition arises where treatments such as antibiotics, oxygen or IV fluids would be beneficial.