Official Do Not Resuscitate Order Form for New York

A New York Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to refuse resuscitation efforts in the event of a medical emergency. This form ensures that your wishes regarding end-of-life care are respected by healthcare providers. If you want to make your preferences clear, consider filling out the form by clicking the button below.

Fill Out Do Not Resuscitate Order Here

In New York, the Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals who wish to communicate their preferences regarding emergency medical treatment, specifically in situations where resuscitation may be necessary. This form allows patients to express their desire not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures if their heart stops beating or they stop breathing. It is important to understand that the DNR Order is not a decision made lightly; it reflects a person's values and wishes about end-of-life care. The form must be signed by the patient or their legally authorized representative, along with a physician, to be valid. Once completed, it should be readily accessible to medical personnel, ensuring that the individual's preferences are honored during critical moments. The DNR Order is part of a broader conversation about advance care planning, which emphasizes the importance of discussing and documenting healthcare wishes in advance, providing peace of mind for both patients and their loved ones.

Document Specifics

Fact Name	Description
Definition	A Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform CPR or other life-saving measures if a patient's heart stops or they stop breathing.
Governing Law	In New York, DNR Orders are governed by the Public Health Law, specifically Article 29-B.
Eligibility	Any adult who is capable of making their own healthcare decisions can create a DNR Order. This includes individuals with terminal illnesses or advanced directives.
Signature Requirement	A DNR Order must be signed by the patient or their healthcare proxy, and it must also be signed by a physician to be valid.
Form Availability	The New York DNR Order form can be obtained from healthcare providers, hospitals, or online through the New York State Department of Health.
Revocation	A DNR Order can be revoked at any time by the patient or their healthcare proxy. This can be done verbally or in writing.

Key takeaways

Understanding the New York Do Not Resuscitate (DNR) Order form is crucial for individuals who wish to express their medical treatment preferences. Here are some key takeaways to consider:

The DNR Order is a legal document that indicates a person's wish not to receive cardiopulmonary resuscitation (CPR) in case of cardiac arrest.
It is important to have a DNR Order if you have specific health conditions or if you are nearing the end of life.
The form must be completed and signed by a licensed physician to be valid.
Patients or their legal representatives should discuss their wishes with healthcare providers before filling out the form.
Once signed, the DNR Order should be placed in a visible location, such as on the refrigerator or with personal medical records.
Healthcare providers are legally required to honor a valid DNR Order, ensuring that the patient’s wishes are respected.
Individuals can revoke or change their DNR Order at any time, but this must be documented properly.
It is advisable to inform family members and caregivers about the existence of the DNR Order to avoid confusion in emergencies.
In New York, a DNR Order can also be part of a larger advance directive, which outlines broader healthcare preferences.

Being informed about the DNR Order process empowers individuals to make decisions that align with their values and healthcare goals. Always consult with healthcare professionals when considering such important choices.

New York Do Not Resuscitate Order Example

New York Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order is created in accordance with New York State laws regarding advance directives and medical decisions. It allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency.

Patient Information:

Name: _____________________________
Date of Birth: _____________________
Address: ____________________________
Phone Number: _____________________

Designated Health Care Proxy (if any):

Name: _____________________________
Phone Number: _____________________

Statement of Medical Wishes:

I, the undersigned, do not wish to receive CPR or any resuscitation efforts should my heart stop or I stop breathing. This decision is made based on my understanding of my medical condition and my personal values regarding end-of-life care.

Signatures:

Patient's Signature: _____________________________

Date: _______________________________________

If signed by Health Care Proxy:

Proxy's Signature: _____________________________

Date: _______________________________________

Witness Statement:

This order was signed in my presence by the patient, who appeared to be of sound mind and understood the nature of the document.

Witness Signature: _____________________________

Date: _______________________________________

Additional Notes:

It is recommended that this DNR order be placed prominently in the patient's medical file and shared with all relevant healthcare providers.

Important Facts about New York Do Not Resuscitate Order

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

A Do Not Resuscitate Order is a legal document that allows individuals to refuse cardiopulmonary resuscitation (CPR) in the event of a medical emergency where their heart or breathing stops. In New York, this order is intended for patients who have a terminal illness or a serious medical condition and wish to avoid aggressive life-saving measures that may not align with their personal values or quality of life preferences.

Who can request a DNR Order?

In New York, a DNR Order can be requested by a patient who is of sound mind and understands the implications of the order. If the patient is unable to make decisions due to incapacity, a legally authorized representative, such as a family member or healthcare proxy, may initiate the process. It's important that the patient's wishes are clearly communicated and documented.

How do I obtain a DNR Order form in New York?

You can obtain a DNR Order form from various sources, including hospitals, healthcare providers, or online through the New York State Department of Health website. The form must be filled out completely and signed by both the patient and their physician. Ensure that you keep copies of the signed form in accessible locations, such as with your healthcare proxy or in your medical records.

What should I do after completing the DNR Order form?

Once you have completed the DNR Order form, it’s crucial to share copies with your healthcare providers, family members, and anyone involved in your care. This ensures that your wishes are known and can be honored in an emergency. Additionally, keep a copy in a place that is easy to find, such as your medical file or with your advance directives.

Can I change or revoke my DNR Order?

Yes, you can change or revoke your DNR Order at any time. To do so, you should clearly communicate your decision to your healthcare providers and family members. It is advisable to complete a new DNR Order form if you decide to revoke or modify your previous order. Always ensure that the most current version of your wishes is documented and distributed to relevant parties.

Documents used along the form

When considering a New York Do Not Resuscitate Order (DNR), it’s important to understand that it often works alongside other documents. These forms help clarify your healthcare wishes and ensure they are respected. Here are some key documents you might encounter:

Health Care Proxy: This document allows you to appoint someone you trust to make medical decisions on your behalf if you are unable to do so. It’s essential for ensuring your preferences are honored.
Power of Attorney for a Child: This legal document empowers a parent or guardian to designate another individual to make decisions on behalf of their child. For guidance on this form, visit floridapdfforms.com/power-of-attorney-for-a-child.
Living Will: A living will outlines your wishes regarding medical treatment in situations where you cannot communicate. It covers various scenarios, not just resuscitation, and provides clear guidance to your healthcare providers.
Do Not Intubate Order: This order specifies that you do not want to be placed on a ventilator or receive intubation. It complements a DNR by addressing another critical aspect of emergency medical care.
Physician Orders for Life-Sustaining Treatment (POLST): A POLST form details your preferences for life-sustaining treatments and is signed by a healthcare professional. It ensures that your wishes are followed across different healthcare settings.
Advance Directive: This is a broader term that includes both living wills and health care proxies. It serves as a way to communicate your healthcare preferences ahead of time, giving you peace of mind.

Understanding these documents can help you make informed decisions about your healthcare. They work together to ensure that your wishes are clear and respected, providing comfort to you and your loved ones during difficult times.

Consider More Do Not Resuscitate Order Forms for US States

Oklahoma Dnr Form - This order can be tailored to address specific conditions or medical circumstances of the patient.

What Does Do Not Resuscitate Mean - A form that guides healthcare providers in respecting patient wishes.

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Out of Hospital Dnr - This order can be revoked at any time by the patient or their representative.

What Is a Dnr in Medical Terms - A DNR does not indicate how long you would like to live; it only specifies your wishes for resuscitation.

Dos and Don'ts

When filling out the New York Do Not Resuscitate Order form, it is important to follow certain guidelines to ensure that your wishes are clearly communicated. Here are five things you should and shouldn't do:

Do ensure that you understand the implications of a Do Not Resuscitate Order.
Do discuss your wishes with your healthcare provider and family members.
Do complete the form accurately, providing all required information.
Do sign and date the form in the presence of a witness, if required.
Do keep a copy of the signed form in a place where it can be easily accessed.

Don't fill out the form under pressure or without understanding its meaning.
Don't forget to inform your healthcare team about the existence of the order.
Don't assume that the order will be honored without proper documentation.
Don't make changes to the form without following the proper procedures.
Don't neglect to review and update the order if your wishes change.