Attorney-Verified New York Do Not Resuscitate Order Template
Contents
The New York Do Not Resuscitate (DNR) Order form serves as a critical document for individuals who wish to make their end-of-life care preferences known. This legally binding form allows patients to refuse cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. It is designed to ensure that medical personnel respect the patient's wishes regarding resuscitation efforts. The form must be completed and signed by a licensed physician, and it requires the patient's or their legal representative's consent. Importantly, the DNR Order is recognized across various healthcare settings, including hospitals, nursing homes, and emergency medical services. By providing clear guidelines, the DNR form aims to alleviate the stress on families and healthcare providers during critical moments. It also emphasizes the importance of communication between patients and their healthcare teams, ensuring that decisions align with individual values and desires. Understanding the nuances of this form can empower individuals to take control of their healthcare decisions and ensure their preferences are honored when they can no longer speak for themselves.
How to Write New York Do Not Resuscitate Order
Filling out the New York Do Not Resuscitate Order form is an important step in expressing your healthcare wishes. After completing the form, it should be shared with your healthcare provider and kept in an accessible location. Here are the steps to fill out the form:
- Obtain the New York Do Not Resuscitate Order form. You can find it online or request it from your healthcare provider.
- Fill in your personal information, including your full name, date of birth, and address.
- Designate a healthcare representative if you wish. This person will be responsible for ensuring your wishes are followed.
- Sign the form in the designated area. Your signature is crucial for validating the order.
- Have the form witnessed. A witness must sign and date the form to confirm that you are of sound mind and voluntarily signing.
- Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and family members.
Once you have completed these steps, ensure that the form is stored safely and remains accessible to those who may need it. Regularly review your wishes to ensure they still align with your preferences.
Misconceptions
There are several misconceptions surrounding the New York Do Not Resuscitate (DNR) Order form. Understanding these can help clarify what a DNR means and how it works.
- A DNR means that no medical care will be provided. This is not true. A DNR specifically applies to resuscitation efforts in case of cardiac arrest or respiratory failure. Patients will still receive all other necessary medical care.
- A DNR is only for terminally ill patients. Many people believe that only those with terminal illnesses can have a DNR. However, anyone can choose to have a DNR regardless of their health status, as long as they understand what it means.
- A DNR is a permanent decision. Some think that once a DNR is signed, it cannot be changed. In reality, a DNR can be revoked or updated at any time by the patient or their healthcare proxy.
- Healthcare providers will not follow a DNR if they disagree with it. This is a common fear, but healthcare providers are legally required to respect a valid DNR order. They must follow the wishes of the patient as outlined in the DNR form.
New York Do Not Resuscitate Order Example
New York Do Not Resuscitate Order (DNR)
This Do Not Resuscitate Order (DNR) is created in accordance with New York State Laws regarding medical orders and end-of-life decisions. This document reflects the wishes of the individual regarding resuscitation and other life-sustaining treatments.
Patient Information:
- Name: _______________________________
- Date of Birth: ________________________
- Address: _____________________________
- City, State, Zip Code: ________________
Health Care Proxy Information:
- Name: _______________________________
- Phone Number: _______________________
- Address: _____________________________
Statement of Wishes:
I, the undersigned, understand that this document outlines my wishes regarding resuscitation and life-sustaining measures in the event of a cardiac arrest or respiratory failure. I do not wish for resuscitative measures to be used if my heart stops beating or if I stop breathing.
By signing this document, I affirm that I am of sound mind and that I voluntarily make this decision free of any undue influence or coercion.
Signed: ________________________________
Date: _________________________________
Witness Information:
- Witness Name: ________________________
- Witness Signature: ____________________
- Date: _________________________________
This Do Not Resuscitate Order should be kept in a visible location and presented to medical personnel in case of an emergency.
Key takeaways
Filling out and utilizing the New York Do Not Resuscitate (DNR) Order form is a significant step for individuals wishing to express their preferences regarding medical interventions. Here are some key takeaways to consider:
- The DNR Order is a legal document that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
- It is essential for individuals to discuss their wishes with family members and healthcare providers before completing the form to ensure everyone understands the decision.
- The form must be signed by a physician, which validates the order and ensures that it is recognized by medical personnel.
- Individuals can revoke or modify the DNR Order at any time, provided they communicate their wishes clearly to their healthcare providers.
- It is advisable to keep the DNR Order in an easily accessible location, such as on the refrigerator or with other important medical documents.
- Healthcare providers are legally obligated to honor a valid DNR Order, but it is important to confirm that the form is properly filled out and signed.
- In New York, the DNR Order applies only to the specific individual named on the form and does not extend to family members or others.
- Individuals should regularly review their DNR Order to ensure it still reflects their current wishes and medical circumstances.
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Dos and Don'ts
When filling out the New York Do Not Resuscitate (DNR) Order form, it’s important to approach the process with care and consideration. Here are some guidelines to help ensure that you complete the form correctly.
- Do ensure that you understand the implications of a DNR order. This decision can have significant effects on your medical care and treatment preferences.
- Do consult with your healthcare provider. Discuss your wishes and any questions you may have about the DNR order with a medical professional.
- Do sign and date the form. Ensure that you provide your signature along with the date to validate the order.
- Do keep copies of the completed form. Distribute copies to your healthcare providers and keep one for your personal records.
- Don't fill out the form without careful thought. Take your time to consider your choices and their potential impact.
- Don't forget to include witnesses if required. Some versions of the form may require signatures from witnesses to be valid.
- Don't assume that verbal instructions are enough. A written DNR order is necessary to ensure your wishes are honored in an emergency.
- Don't neglect to inform your family members. Make sure your loved ones are aware of your decision and understand your wishes.
Similar forms
The Advance Directive is a legal document that outlines a person's preferences for medical treatment in situations where they cannot communicate their wishes. Like the New York Do Not Resuscitate Order (DNR), it allows individuals to express their desires regarding life-sustaining measures. Both documents serve to ensure that medical professionals respect a person's choices, particularly in critical situations. However, an Advance Directive can cover a broader range of medical decisions, while a DNR specifically addresses resuscitation efforts.
A Living Will is another important document similar to the DNR. It details an individual's preferences for end-of-life care and can include instructions about resuscitation, pain management, and other medical treatments. While a DNR focuses solely on the refusal of resuscitation, a Living Will provides a comprehensive view of a person's healthcare wishes, ensuring that their overall preferences are respected.
The Physician Orders for Life-Sustaining Treatment (POLST) form is another document that shares similarities with the DNR. POLST is designed for individuals with serious health conditions and translates their treatment preferences into actionable medical orders. Like a DNR, it communicates a patient's wishes regarding resuscitation, but POLST can also address other interventions, making it a more comprehensive tool for managing medical care.
The Medical Power of Attorney grants an individual the authority to make healthcare decisions on behalf of another person. This document is similar to a Healthcare Proxy but may cover a wider range of decisions beyond end-of-life care. Both documents ensure that a person's healthcare preferences, including those related to resuscitation, are honored by the appointed representative.
The Do Not Intubate (DNI) order is closely related to the DNR. While a DNR specifically prohibits resuscitation efforts, a DNI indicates that a patient does not wish to be intubated or placed on a ventilator. Both orders aim to prevent unwanted medical interventions, focusing on the patient’s comfort and quality of life during critical health situations.
The Comfort Care Order emphasizes providing relief from pain and stress rather than pursuing aggressive treatments. Similar to a DNR, it prioritizes the patient's comfort and dignity at the end of life. While a DNR addresses resuscitation, a Comfort Care Order focuses on ensuring that patients receive compassionate care without invasive procedures.
The Do Not Hospitalize (DNH) order is another document that aligns with the principles of a DNR. It expresses a patient’s wish to avoid hospitalization, particularly in situations where they may not benefit from aggressive treatments. Both documents reflect a desire for a specific approach to care, emphasizing comfort and quality of life over invasive medical interventions.
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The End-of-Life Care Plan outlines a person’s wishes regarding their care as they approach the end of life. Similar to a DNR, it can include preferences about resuscitation and other medical interventions. This document provides a more holistic view of a patient’s desires, ensuring that their values are respected throughout the dying process.
Lastly, the Patient Bill of Rights establishes the rights of patients within healthcare settings, including the right to make decisions about their care. While not a directive like the DNR, it reinforces the importance of honoring a patient’s choices regarding resuscitation and other treatments. Both documents aim to protect patient autonomy and ensure that healthcare providers respect individual preferences.