Homepage Attorney-Approved Do Not Resuscitate Order Template Attorney-Approved Do Not Resuscitate Order Document for the State of New York
Outline

The New York Do Not Resuscitate Order (DNR) form serves as a crucial document for individuals who wish to express their preferences regarding medical interventions in the event of a cardiac arrest or respiratory failure. This form allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining treatments. It is essential for ensuring that healthcare providers understand and respect the patient's wishes. The DNR form must be completed and signed by a physician, and it should be readily available in medical settings to guide emergency response teams. In addition, the form requires the patient or their legal representative to acknowledge their understanding of the implications of the order. Understanding the DNR form and its components can help individuals make informed decisions about their end-of-life care, providing peace of mind for both patients and their families.

Sample - New York Do Not Resuscitate Order Form

New York Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is created in accordance with New York State laws governing advance directives. It is intended to communicate the wishes of the patient regarding resuscitation efforts in the event of a medical emergency.

Patient Information:

  • Name: _______________________________
  • Date of Birth: ________________________
  • Address: _____________________________
  • City: ________________________________
  • State: New York
  • Zip Code: ___________________________

Healthcare Proxy Information:

  • Name of Healthcare Proxy: __________________________
  • Phone Number: _________________________________
  • Address: ______________________________________

Patient's Wishes:

The patient hereby requests that no resuscitative measures be taken in the event of cardiac arrest or respiratory failure. This includes, but is not limited to:

  1. Cardiopulmonary resuscitation (CPR)
  2. Intubation and mechanical ventilation
  3. Defibrillation

This order is effective immediately upon signing and will remain in effect until revoked by the patient or a legally authorized representative.

Signature:

_______________________________ Date: ________________

Witness Information:

  • Name: _______________________________
  • Signature: ___________________________
  • Date: ________________________________

This document must be kept in a location that is easily accessible to emergency medical personnel and healthcare providers.

File Characteristics

Fact Name Description
Purpose The New York Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation efforts in the event of cardiac or respiratory arrest.
Governing Law This form is governed by New York Public Health Law, specifically Article 29-B.
Eligibility Any adult who is capable of making health care decisions can complete a DNR Order, or it can be completed by a legally authorized representative.
Form Accessibility The DNR Order form is available online and must be printed, signed, and kept accessible to emergency medical personnel.

Detailed Guide for Filling Out New York Do Not Resuscitate Order

Filling out the New York Do Not Resuscitate Order form is a straightforward process that requires careful attention to detail. After completing the form, it is essential to ensure that it is signed and dated appropriately. This document will guide healthcare providers in understanding your wishes regarding resuscitation in emergency situations.

  1. Obtain a copy of the New York Do Not Resuscitate Order form. This can typically be found online or through healthcare facilities.
  2. Fill in the patient’s full name as it appears on their identification.
  3. Provide the patient’s date of birth. This helps to verify their identity.
  4. Indicate the patient’s address, including street, city, state, and zip code.
  5. Identify the patient’s attending physician. Include their name and contact information.
  6. Clearly state the reason for the Do Not Resuscitate Order. This may include specific medical conditions or preferences.
  7. Have the patient or their legal representative sign and date the form. This signature confirms their understanding and agreement with the order.
  8. Ensure that the form is witnessed by at least one person who is not a relative or the attending physician.
  9. Make copies of the completed form for the patient’s records and for their healthcare providers.
  10. Keep the original form in a safe but accessible place, such as with the patient’s medical records or with their healthcare proxy.

Obtain Answers on New York Do Not Resuscitate Order

  1. What is a Do Not Resuscitate (DNR) Order in New York?

    A Do Not Resuscitate Order is a legal document that allows a person to refuse resuscitation efforts in the event of a cardiac or respiratory arrest. In New York, this order is intended to respect the wishes of individuals who may not want aggressive life-saving measures taken if they are in a terminal condition or experiencing irreversible decline.

  2. Who can request a DNR Order?

    In New York, a DNR Order can be requested by an individual who is capable of making their own medical decisions. If the individual is unable to make decisions, a legally authorized representative, such as a family member or healthcare proxy, may request the order on their behalf.

  3. How is a DNR Order completed?

    The DNR Order must be completed using the official form provided by the New York State Department of Health. This form requires the signature of the patient or their authorized representative, as well as the signature of a physician. It is important to ensure that all sections of the form are filled out accurately to avoid any confusion during an emergency.

  4. Where should the DNR Order be kept?

    The DNR Order should be kept in a place that is easily accessible to emergency medical personnel. It is advisable to keep a copy in the patient’s medical records, at home, and to provide copies to family members. Some individuals choose to wear a medical alert bracelet or necklace that indicates their DNR status.

  5. Can a DNR Order be revoked?

    Yes, a DNR Order can be revoked at any time. The individual or their representative can verbally communicate their wish to revoke the order, or they can destroy the original document. It is essential to inform healthcare providers of any changes to ensure that the patient’s current wishes are respected.

  6. What happens if a DNR Order is not followed?

    If a DNR Order is not followed, it may lead to unwanted resuscitation efforts that go against the wishes of the patient. Healthcare providers are legally obligated to adhere to the DNR Order once it has been properly documented and signed. If there are concerns about compliance, it is crucial to discuss them with the healthcare team to ensure that everyone is on the same page.

  7. How can I ensure my DNR Order is honored?

    To ensure that your DNR Order is honored, communicate your wishes clearly with your healthcare providers and family members. Make sure they are aware of your DNR status and have copies of the order. Regularly review the order and discuss it with your healthcare team, especially if your health status changes.

Common mistakes

Filling out a New York Do Not Resuscitate (DNR) Order form can be a daunting task, and it’s crucial to get it right. Many people make common mistakes that can lead to confusion or unintended consequences. Here are ten mistakes to avoid when completing this important document.

First, one of the most frequent errors is failing to sign the form. A DNR Order is not valid without the signature of the patient or their legal representative. Make sure to check that all necessary signatures are in place before submitting the form.

Secondly, not dating the form can create issues. A DNR Order should always include the date it was completed. This helps healthcare providers understand the timeline of your wishes and ensures that the order is current.

Another common mistake is not providing enough information about the patient. The form should clearly identify the patient’s full name, date of birth, and any other identifying details. This prevents any mix-ups with other patients and ensures that your wishes are respected.

Some people overlook the importance of discussing their DNR wishes with family members. Failing to communicate your decision can lead to confusion and conflict during a medical emergency. Having an open conversation can help everyone understand your choices and respect them.

Additionally, neglecting to review the form for errors can be a significant oversight. Simple mistakes, such as misspellings or incorrect information, can undermine the validity of the document. Always double-check your work before finalizing the form.

Another mistake is using outdated versions of the form. Make sure you are using the most current DNR Order form available in New York. Laws and regulations can change, and using an outdated form may lead to complications.

Some individuals mistakenly think that a DNR Order is only necessary for terminal illnesses. In reality, anyone can choose to have a DNR Order in place, regardless of their health status. Understanding that this is a personal choice is essential.

People also often forget to provide copies of the DNR Order to relevant parties. After completing the form, it’s vital to share copies with your healthcare provider, family members, and anyone else involved in your care. This ensures that your wishes are known and can be honored.

Another pitfall is not updating the DNR Order when circumstances change. Life events, such as a change in health status or a change in your wishes, may necessitate a revision of the document. Regularly reviewing your DNR Order can help keep it aligned with your current preferences.

Lastly, some individuals mistakenly assume that a DNR Order is only for hospital settings. It’s important to understand that a DNR applies in various healthcare settings, including at home or in a nursing facility. Be clear about where you want your DNR wishes to be honored.

By avoiding these common mistakes, you can ensure that your DNR Order accurately reflects your wishes and is respected by healthcare providers. Taking the time to fill out this form correctly can provide peace of mind for you and your loved ones.

Documents used along the form

A New York Do Not Resuscitate (DNR) Order form is an important document for individuals who wish to communicate their preferences regarding resuscitation efforts in medical emergencies. Along with the DNR form, several other documents may be used to ensure that a person's healthcare wishes are respected. Below is a list of some common forms and documents associated with a DNR order.

  • Health Care Proxy: This document allows a person to appoint someone else to make medical decisions on their behalf if they become unable to do so. It provides clarity on who can act in the patient's best interest.
  • Living Will: A living will outlines specific medical treatments an individual does or does not want in certain situations, such as terminal illness or irreversible conditions. It serves as guidance for healthcare providers and family members.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that specifies a patient's wishes regarding life-sustaining treatments. It is designed for individuals with serious illnesses and ensures that their preferences are honored across different care settings.
  • Advance Directive: An advance directive is a general term that encompasses both health care proxies and living wills. It allows individuals to express their medical preferences and appoint decision-makers ahead of time.
  • Do Not Intubate (DNI) Order: This order specifies that a patient should not be placed on a ventilator or receive intubation in the event of respiratory failure. It complements a DNR order by addressing specific interventions.
  • Organ Donation Form: This document allows individuals to express their wishes regarding organ donation after death. It can be included with other advance care planning documents to ensure that all preferences are known.
  • Emergency Medical Services (EMS) Bracelet or Card: Wearing a bracelet or carrying a card that indicates a DNR order can help ensure that emergency personnel are aware of a person's wishes in a crisis situation.

These documents work together to create a comprehensive plan for an individual's healthcare preferences. It is important for individuals to discuss their wishes with family members and healthcare providers to ensure that everyone understands their intentions.

Similar forms

  • Advance Healthcare Directive: This document allows individuals to outline their healthcare preferences in advance. It provides guidance on medical decisions when someone cannot communicate their wishes.
  • Living Will: A living will specifically details the types of medical treatment a person wants or does not want in situations where they are unable to express their preferences.
  • Power of Attorney for Healthcare: This form designates a trusted person to make healthcare decisions on behalf of someone if they become incapacitated. It complements a DNR by ensuring someone advocates for the patient's wishes.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that outlines a patient's preferences for treatment, including resuscitation. It is often used for those with serious illnesses.
  • Do Not Intubate Order: Similar to a DNR, this order specifically states that a patient does not want to be intubated if they cannot breathe on their own. It focuses on airway management rather than overall resuscitation.
  • Emergency Medical Services (EMS) Do Not Resuscitate Form: This form is used by emergency medical services to ensure that a DNR order is recognized in emergency situations. It helps prevent unwanted resuscitation attempts outside of a hospital setting.

Dos and Don'ts

When filling out the New York Do Not Resuscitate Order form, there are important dos and don'ts to keep in mind. Here’s a straightforward list to help you navigate the process.

  • Do ensure you understand the implications of a Do Not Resuscitate Order.
  • Do have a conversation with your healthcare provider about your wishes.
  • Do fill out the form completely and accurately.
  • Do sign and date the form where indicated.
  • Don't leave any sections blank unless instructed.
  • Don't forget to keep a copy for your records and share it with your healthcare proxy.

These steps will help ensure that your wishes are clearly communicated and respected. Taking the time to fill out this form correctly is essential for your peace of mind and the clarity of your healthcare decisions.

Misconceptions

Understanding the New York Do Not Resuscitate (DNR) Order form is essential for individuals and families making critical healthcare decisions. However, several misconceptions often arise, leading to confusion. Below is a list of common misunderstandings regarding the DNR Order form in New York.

  • A DNR order means that no medical care will be provided. This is false. A DNR order specifically pertains to the withholding of cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. Other medical treatments and interventions can still be administered.
  • DNR orders are only for terminally ill patients. This is a misconception. While many individuals who opt for a DNR may be facing serious health issues, a DNR order can be appropriate for anyone who wishes to avoid CPR in specific circumstances, regardless of their overall health status.
  • A DNR order is permanent and cannot be changed. In reality, individuals can revoke or modify a DNR order at any time. It is important to communicate any changes to healthcare providers to ensure that the patient’s wishes are respected.
  • All healthcare providers recognize DNR orders. This is not entirely true. While most healthcare facilities and providers in New York are trained to honor DNR orders, it is crucial to ensure that the order is properly documented and accessible to all involved in the patient’s care.
  • A DNR order must be signed by a doctor. While a physician's signature is typically required for a DNR order to be valid, patients can also create a DNR order through a legally recognized advance directive, which may not always necessitate a doctor's signature.
  • Having a DNR order means I will receive no care at all. This is misleading. A DNR order does not mean a person will receive no medical care. It only specifies that CPR should not be performed in case of a cardiac or respiratory arrest.
  • Once a DNR is in place, it applies in all situations. This is incorrect. A DNR order typically applies only in emergency situations involving cardiac or respiratory arrest. In other medical contexts, such as during surgery or other procedures, different protocols may apply.
  • Family members can override a DNR order. Generally, this is not the case. A DNR order reflects the patient’s wishes. Family members cannot override it unless they have been legally designated as healthcare proxies with the authority to make decisions on behalf of the patient.
  • All DNR orders are the same. This is a misconception. DNR orders can vary by state and may have different requirements or formats. It is essential to use the correct form for New York to ensure it is legally valid.

Understanding these misconceptions can empower individuals and families to make informed decisions regarding end-of-life care and ensure that their wishes are respected in critical situations.

Key takeaways

The New York Do Not Resuscitate Order (DNR) form is an important document that outlines a person's wishes regarding resuscitation efforts in the event of a medical emergency. Here are key takeaways regarding its use and completion:

  • Eligibility: The DNR form is intended for individuals who have a serious illness or condition and wish to forgo resuscitation efforts in the event of cardiac or respiratory arrest.
  • Completion: The form must be completed by a qualified healthcare provider and signed by the patient or their legal representative to be valid.
  • Visibility: It is crucial to ensure that the DNR form is easily accessible to emergency medical personnel and healthcare providers. Keeping a copy in a visible location can facilitate its recognition during emergencies.
  • Revocation: Individuals have the right to revoke their DNR order at any time. This can be done verbally or in writing, and healthcare providers must respect the individual's updated wishes.