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.
Queens New York Do Not Resuscitate Request - DNR
State:
Multi-State
County:
Queens
Control #:
US-PRM-12
Format:
Word;
Rich Text
Instant download
Description
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FAQ
The DNR can not be expired. The facility staff must provide a copy of the order Page 3 and/or patient's chart with the recorded DNR order to the ambulance crew.
Out of hospital DNRs do not expire. The Out of Hospital DNR form and/or bracelet should be taken with the patient. All Article 28 licensed facilities are required to issue, review and maintain DNR orders.
There are three main circumstances in which the law allows DNR decisions to be made: Where a patient, with capacity, asks not to be resuscitated. This must be respected and a DNR order implemented to alert all healthcare professionals not to attempt resuscitation.
notresuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.
A DNR order must be written by a doctor. The doctor will typically explain your options to you and your family, outlining what the DNR entails. With your consent, the doctor will create the order and enter it into your medical record. It will then be visible and applicable to any medical professionals who treat you.
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.
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.
Any licensed physician should have a blank DNR Order or a MOLST form. If you need to provide a form to your physician, you can get one from the NY state website.
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
Ordering Information: Submit completed order request form (form # 014-0350-93) to OSSDistribution@ontario.ca (preferred option) or fax to 416-679-8192.
