Get Ct Metal Bracelet Dnr Order Form

Completing the CT Metal Bracelet Do Not Resuscitate (DNR) Order Form online is an essential process for ensuring that a person's healthcare preferences are respected. This guide provides clear instructions to help users fill out the form accurately and efficiently.

Follow the steps to successfully complete the CT Metal Bracelet DNR Order Form online.

1. Click the ‘Get Form’ button to obtain the CT Metal Bracelet DNR Order Form and access it in an editable format.
2. Provide the ordering institution or licensed physician name in the designated field.
3. Fill in the contact person's name, mailing address, and phone number for communication purposes.
4. Attach a completed Do Not Resuscitate Verification Order that is signed and issued by a licensed Connecticut Physician, ensuring a valid copy is included.
5. Include a copy of the patient’s valid driver’s license, social security card, or birth certificate. Note that other forms of identification will not be accepted, and these documents will be kept confidential.
6. Indicate the quantity of metal bracelets being ordered, keeping in mind the cost of $23.32 per bracelet, which includes sales tax and shipping. Note that personal checks are not accepted.
7. Specify if the payment will be made by corporate check or money order, payable to the Connecticut College of Emergency Physicians.
8. Complete engraving details, including the full legal name for the front engraving and the physician’s name and phone number for the reverse engraving. Each field allows a maximum of 20 letters.
9. Select the type of bracelet required by checking either the adult or pediatric bracelet option.
10. Once all fields are completed, review the form for accuracy, save your changes, and prepare for submission by mailing the form to the Connecticut College of Emergency Physicians along with the payment.

Start completing your CT Metal Bracelet DNR Order Form online now to ensure your healthcare preferences are documented.