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Official Do Not Resuscitate Order Document for New York

A New York Do Not Resuscitate Order form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form ensures that healthcare providers respect a person's decision to forgo life-saving measures, focusing instead on comfort and quality of life. If you're considering this important decision, take the next step by filling out the form below.

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In the bustling landscape of healthcare, the New York Do Not Resuscitate (DNR) Order form stands as a crucial document for individuals facing serious medical decisions. This form allows patients to express their wishes regarding resuscitation efforts in the event of cardiac arrest or respiratory failure. It is vital for ensuring that a person's preferences are honored when they are unable to communicate. The DNR form must be filled out and signed by a licensed physician, and it requires clear identification of the patient, including their name and date of birth. Importantly, the form should be readily accessible, often kept in a visible place, so that medical personnel can easily locate it during emergencies. Additionally, patients and their families should understand that the DNR does not affect the quality of care; it simply directs healthcare providers to refrain from certain life-saving measures. By understanding the nuances of the DNR Order form, individuals can take proactive steps to ensure their healthcare wishes are respected, fostering peace of mind during challenging times.

Sample - New York Do Not Resuscitate Order Form

New York Do Not Resuscitate (DNR) Order Template

This Do Not Resuscitate Order (DNR) is prepared in accordance with the New York State Public Health Law and is intended for use in medical situations where the individual does not wish to receive cardiopulmonary resuscitation (CPR) or other life-sustaining treatments in the event of cardiac or respiratory arrest.

Please complete the sections below:

Patient's Name: ___________________________________
Date of Birth: ________________________________
Address: _____________________________________
City, State, Zip Code: ______________________
Patient's Phone Number: ______________________

The following sections must be completed by the healthcare provider:

Healthcare Provider's Name: _____________________
Provider's License Number: ______________________
Provider's Contact Information: _________________

Declaration of DNR Order:

I, the undersigned, hereby declare my wish that in the event of my cardiac arrest or respiratory arrest, no resuscitation measures, including but not limited to CPR, be initiated. I fully understand the implications of this decision.

Signature of Patient or Authorized Representative: _________________________________

Date: ___________________________________________________

Witness Signature: ____________________________________

Date: ___________________________________________________

This DNR order remains in effect unless revoked in writing and should be kept in a readily accessible location, such as within the patient's medical records.

Document Information

Fact Name	Description
Definition	The New York Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation efforts in the event of cardiac arrest or respiratory failure.
Governing Law	This form is governed by New York Public Health Law, specifically Section 2994-d, which outlines the requirements for a valid DNR order.
Eligibility	Any individual who is 18 years or older and capable of making their own medical decisions can complete a DNR order.
Signature Requirement	The DNR order must be signed by the patient, or by a legally authorized representative if the patient is unable to sign.

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Misconceptions

Understanding the New York Do Not Resuscitate (DNR) Order form is crucial for individuals and families making end-of-life decisions. However, several misconceptions can cloud this important topic. Below are seven common misunderstandings about the DNR form.

A DNR order means no medical care at all. Many people believe that having a DNR order means that a person will receive no medical care. In reality, a DNR order only applies to resuscitation efforts in the event of cardiac arrest. Other forms of medical treatment and care continue as needed.
Anyone can fill out a DNR order. While it is true that individuals can express their wishes regarding resuscitation, only certain qualified individuals, such as physicians, can officially complete and sign a DNR order. This ensures that the order is valid and recognized by medical professionals.
A DNR order is permanent and cannot be changed. Some people think that once a DNR order is signed, it cannot be altered. This is not the case. Individuals can revoke or modify their DNR orders at any time, as long as they are mentally competent to do so.
Having a DNR order means giving up hope. Many individuals fear that a DNR order signifies a lack of hope or a desire to hasten death. In truth, a DNR order is a personal choice reflecting an individual’s values and preferences regarding end-of-life care.
A DNR order is only for terminally ill patients. There is a common belief that DNR orders are only appropriate for those who are terminally ill. However, anyone can choose to have a DNR order, regardless of their health status, based on their personal wishes.
Emergency responders will ignore a DNR order. Some people worry that emergency medical personnel will not respect a DNR order. In fact, emergency responders are trained to recognize and honor valid DNR orders, provided they are properly documented and presented at the time of an emergency.
A DNR order is the same as a living will. While both documents relate to end-of-life decisions, they serve different purposes. A DNR order specifically addresses resuscitation efforts, whereas a living will outlines a person's wishes regarding other medical treatments and interventions.

By clarifying these misconceptions, individuals can make informed decisions about their medical care preferences and ensure their wishes are respected.

Documents used along the form

When considering a New York Do Not Resuscitate (DNR) Order, it's essential to understand that several other documents may complement this directive. These forms help clarify your healthcare wishes and ensure that your preferences are respected. Below is a list of related documents that are commonly used alongside the DNR Order.

Health Care Proxy: This document allows you to appoint someone to make medical decisions on your behalf if you become unable to do so. It ensures that your healthcare preferences are honored even when you cannot communicate them.
Living Will: A living will outlines your wishes regarding medical treatment in situations where you are terminally ill or permanently unconscious. It provides guidance to your healthcare providers and loved ones about the types of interventions you do or do not want.
Operating Agreement: Essential for LLCs, this document outlines the management structure and operational guidelines for a limited liability company in California. For more information, visit California PDF Forms.
Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that details your preferences for life-sustaining treatments. Unlike a DNR, which focuses solely on resuscitation, POLST can cover a broader range of medical interventions.
Advance Directive: This is a broader term that includes both living wills and health care proxies. It serves as a legal document where you can express your healthcare preferences and designate someone to make decisions for you.
Do Not Intubate (DNI) Order: Similar to a DNR, a DNI order specifically states that you do not wish to be placed on a ventilator or have breathing assistance in the event of respiratory failure.
Organ Donation Consent: If you wish to donate your organs after death, this document allows you to express your consent. It can be included in your advance directives to ensure your wishes are known.
Emergency Medical Services (EMS) Form: This form provides first responders with information about your DNR or other medical orders. It helps ensure that your wishes are followed in emergency situations.

Understanding these documents can help you make informed decisions about your healthcare preferences. Each one plays a crucial role in ensuring that your wishes are respected and communicated effectively. Always consult with a healthcare professional or legal advisor to ensure your documents are completed correctly and reflect your intentions.