This is a form initiated by a patient requesting that he/she not be resuscitated should he/she stop breathing or should his/her heart stop beating. This form is also to be signed by a physician attesting to patient's wishes and to be placed in the patient's file.
Nassau New York Do Not Resuscitate Request - DNR
State:
Multi-State
County:
Nassau
Control #:
US-PRM-12
Format:
Word;
Rich Text
Instant download
Description
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How to fill out Do Not Resuscitate Request - DNR?
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FAQ
You decide deciding in advance to refuse CPR You can make it clear to your doctor or medical team that you do not want CPR if your heart or breathing stops. Your doctor may complete a DNACPR form to indicate this and put it in your medical records.
How is a DNR Order Created? The doctor writes the DNR order in your medical record if you are in the hospital. Your doctor can tell you how to get a wallet card, bracelet, or other DNR documents to have at home or in non-hospital settings. Standard forms may be available from your state's Department of Health.
A DNR is a request not to have CPR if your heart stops or if you stop breathing. You can use an advance directive form or tell your doctor that you don't want to be resuscitated. Your doctor will put the DNR order in your medical chart. Doctors and hospitals in all states accept DNR orders.
A family member or close friend can consent to a DNR order only when you are unable to decide for yourself and you have not appointed someone to decide for you under a health care proxy document.
Common law and legislation in some states allow for an individual to make an advance health directive (DNR), which effectively informs the patient's health team regarding the care the patient would like in the future should the patient become unable to make medical decisions. It can cover the withholding of CPR.
An adult patient in a health care facility can consent to a DNR order orally or in writing. The law does not require any particular form of recording the patient's consent, although many health care facilities have prepared forms. A patient's decision should not be delayed for lack of forms.
Generally, a DNR is executed when an individual has a history of chronic disease or terminal illness, such as chronic lung disease or heart disease, that has in the past or may in the future necessitate cardiopulmonary resuscitation (CPR), and the patient no longer wishes to be revived because of concerns that the use
The most important factor to bear in mind is that the law does not require a patient, or their family to consent to a DNR order. This means a doctor can issue a DNR order, even if you do not want one (see section on what to do if there is a disagreement).
An adult patient may consent to a DNR order orally by informing a physician, or in writing, such as a living will, if two witnesses are present. In addition, the Health Care Proxy Law allows you to appoint someone you trust to make decisions about CPR and other treatments if you become unable to decide for yourself.