Get Division Of Public Health

Filling out the Division of Public Health form is an essential process for individuals wishing to establish a Do Not Resuscitate (DNR) order. This guide provides clear, step-by-step instructions to assist users in completing the form accurately and effectively.

Follow the steps to complete the DNR order form online.

1. Click the ‘Get Form’ button to obtain the DNR order form and access it in the editor.
2. Begin by reviewing the background information provided on the form. This section explains the purpose and implications of a DNR order, ensuring you understand the decision being made.
3. In the designated fields, print the patient's name, date of birth, and address (including city, state, and zip code). Ensure that all details are accurate and clearly written.
4. Indicate the gender of the patient by selecting either 'Male' or 'Female.' This information is used for identification purposes.
5. Read the statement of understanding carefully. This section confirms that the patient, legal guardian, or healthcare agent understands the implications of the DNR order. Acknowledge the understanding by marking the appropriate checkbox.
6. Obtain the signature of the patient, legal guardian, or healthcare agent in the specified area. It is vital to circle the title of the individual signing this form.
7. Enter the date signed next to the signature area to validate the order.
8. The attending healthcare professional must print their name and provide their phone number in the appropriate fields.
9. Ensure that the attending healthcare professional signs and dates the form. Both signatures are necessary for the order to be valid.
10. After completing the form, save your changes. You can download, print, or share the DNR order as needed. Keep a copy for your records and provide a copy to your primary care physician.

Take action now and fill out the DNR order form online to ensure your healthcare decisions are respected.