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Homepage ➙ Attorney-Approved Do Not Resuscitate Order Document ➙ Attorney-Verified New Hampshire Do Not Resuscitate Order Template
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In New Hampshire, the Do Not Resuscitate (DNR) Order form is an important document for individuals who wish to express their preferences regarding medical treatment in the event of a life-threatening situation. This form allows patients to indicate that they do not want to receive cardiopulmonary resuscitation (CPR) or other life-saving measures if their heart stops or if they stop breathing. It is designed to ensure that a person's wishes are respected, particularly when they may be unable to communicate them due to medical circumstances. The DNR form must be completed and signed by a licensed physician, and it should be readily accessible to emergency medical personnel. Understanding how to properly fill out and utilize this form can provide peace of mind for patients and their families, ensuring that medical decisions align with personal values and desires. It is crucial to discuss this decision with loved ones and healthcare providers to ensure everyone is aware of the individual’s wishes. The DNR Order is not just a legal document; it is a reflection of a person’s values and choices regarding end-of-life care.

How to Write New Hampshire Do Not Resuscitate Order

To complete the New Hampshire Do Not Resuscitate Order form, follow these steps carefully. Ensure that all required information is filled out accurately to avoid any issues. Once the form is completed, it will need to be signed and dated by the appropriate parties.

  1. Obtain the New Hampshire Do Not Resuscitate Order form. This can be found online or through healthcare providers.
  2. Fill in the patient's full name in the designated section.
  3. Provide the patient's date of birth.
  4. Indicate the patient's address, including city and state.
  5. Complete the section regarding the patient's medical condition, if required.
  6. Have the patient or their legal representative sign the form in the appropriate area.
  7. Ensure that the date of the signature is also included.
  8. Consult with the healthcare provider to review the completed form.
  9. Make copies of the signed form for personal records and for the healthcare provider.
  10. Distribute the copies to relevant parties, such as family members and healthcare facilities.

Misconceptions

Understanding the New Hampshire Do Not Resuscitate (DNR) Order form can be challenging due to various misconceptions. Here are six common misunderstandings:

  • A DNR order means no medical treatment at all. Many people believe that a DNR order prevents all medical interventions. In reality, it specifically pertains to resuscitation efforts in the event of cardiac or respiratory arrest. Other medical treatments can still be provided.
  • Only terminally ill patients can have a DNR order. While DNR orders are often associated with terminal illnesses, they can be appropriate for anyone who wishes to avoid resuscitation in certain medical situations, regardless of their overall health status.
  • A DNR order is permanent and cannot be changed. Some individuals think that once a DNR order is established, it cannot be altered. However, patients or their authorized representatives can revoke or modify the order at any time, based on changing preferences or health conditions.
  • DNR orders are only for hospitals. There is a misconception that DNR orders are only applicable in hospital settings. In fact, DNR orders can be honored in various healthcare environments, including nursing homes, hospice care, and even at home, as long as the proper documentation is in place.
  • Healthcare providers will not provide care if a DNR is in place. Some people fear that having a DNR order means healthcare providers will neglect their care. This is not true. Medical staff are obligated to provide appropriate care and comfort measures, even if resuscitation is not an option.
  • Anyone can create a DNR order. There is a belief that anyone can simply write a DNR order. In New Hampshire, a valid DNR order must be signed by a physician and the patient or their legal representative, ensuring that it is an informed decision made with medical guidance.

Addressing these misconceptions can help individuals make informed decisions regarding their healthcare preferences and advance directives.

New Hampshire Do Not Resuscitate Order Example

New Hampshire Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is established in accordance with New Hampshire state laws. This document expresses the wishes of the individual regarding medical treatment in the event of a cardiac or respiratory arrest.

Patient Information:

  • Full Name: ______________________________
  • Date of Birth: __________________________
  • Address: _________________________________
  • City: ____________________________________
  • State: NH
  • Zip Code: ________________________________
  • Phone Number: ____________________________

Healthcare Proxy Information:

  • Proxy Name: ______________________________
  • Relationship: _____________________________
  • Phone Number: ____________________________
  • Alternate Contact Name: ____________________
  • Alternate Contact Phone Number: ___________

Do Not Resuscitate Directive:

I, the undersigned, knowingly and voluntarily request that in the event my heart stops beating or I stop breathing, medical personnel or emergency responders do not initiate resuscitation efforts.

This directive does not apply in situations where I can regain consciousness or when my heart or breathing might return spontaneously without medical intervention.

Signature and Acknowledgments:

  • Patient Signature: ________________________ Date: ______________
  • Proxy Signature (if applicable): __________ Date: ______________

Witness Name: ___________________________

Witness Signature: ________________________ Date: ______________

This document should remain with the patient or be easily accessible to healthcare providers at all times. It is vital that it reflects the patient's current wishes.

Key takeaways

Here are some important points to keep in mind when filling out and using the New Hampshire Do Not Resuscitate Order form:

  1. The form must be completed by a licensed physician.
  2. The patient or their legal representative must sign the form.
  3. It is essential to discuss the decision with the physician to understand its implications.
  4. The form should clearly state the patient's wishes regarding resuscitation.
  5. Keep a copy of the completed form in a visible location, such as on the refrigerator.
  6. Provide copies to family members and caregivers to ensure everyone is informed.
  7. The order is only valid when signed and dated by the physician.
  8. Review the form regularly, especially if the patient's health status changes.
  9. Understand that the order applies only to resuscitation efforts, not other medical treatments.
  10. Be aware that the form can be revoked at any time by the patient or their representative.

By following these key points, you can ensure that the Do Not Resuscitate Order reflects the patient's wishes and is used appropriately in medical situations.

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Dos and Don'ts

When filling out the New Hampshire Do Not Resuscitate Order form, it's important to be careful and thorough. Here’s a list of things to do and avoid:

  • Do ensure you understand the implications of a DNR order.
  • Do discuss your wishes with your healthcare provider.
  • Do have a witness present when signing the form.
  • Do keep a copy of the completed form in a visible location.
  • Don't fill out the form without consulting your doctor.
  • Don't sign the form if you feel pressured.
  • Don't forget to update the form if your wishes change.
  • Don't assume family members will understand your wishes without discussing them.

Similar forms

The New Hampshire Do Not Resuscitate Order (DNR) form is similar to a living will, which outlines an individual's preferences regarding medical treatment in the event they become incapacitated. A living will typically specifies the types of medical interventions a person wishes to receive or decline, including life-sustaining treatments. Both documents serve to communicate a person's healthcare wishes to medical professionals and family members, ensuring that their preferences are respected during critical moments.

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An advance healthcare directive also shares similarities with the DNR form. This document allows individuals to appoint a healthcare proxy or agent to make medical decisions on their behalf if they are unable to do so. Like the DNR, an advance healthcare directive can include specific instructions about the types of medical treatment a person does or does not want, providing clarity and guidance to healthcare providers and loved ones.