Blank New York Do Not Resuscitate Order Form

• Advance Directive: This document outlines a person's preferences for medical treatment in situations where they cannot communicate their wishes. Like a DNR, it provides guidance to healthcare providers about the patient's desires.
• Hold Harmless Agreement: This document is essential in various transactions, protecting parties by transferring liability and ensuring that risks are clearly understood. For more information, you can refer to the Hold Harmless Agreement.
• Living Will: Similar to an advance directive, a living will specifically addresses end-of-life care decisions. It details what medical interventions a person does or does not want, paralleling the intent of a DNR.
• Healthcare Power of Attorney: This document designates an individual to make healthcare decisions on someone’s behalf. It complements a DNR by ensuring that a trusted person can advocate for the patient's wishes.
• Physician Orders for Life-Sustaining Treatment (POLST): A POLST form provides specific medical orders regarding treatment preferences. It is similar to a DNR in that it communicates a patient's wishes regarding resuscitation and other life-sustaining measures.
• Do Not Intubate (DNI) Order: This order specifies that a patient should not be intubated in case of respiratory failure. It aligns with a DNR by indicating a preference to avoid aggressive life-saving measures.
• Comfort Care Order: This document focuses on providing comfort rather than curative treatment. It shares similarities with a DNR by prioritizing quality of life over invasive procedures.
• Emergency Medical Services (EMS) Do Not Resuscitate Form: This form is used by EMS personnel to respect a patient's DNR wishes in emergency situations, ensuring that the patient's preferences are honored outside of a hospital setting.
• Patient Restraint Orders: While not directly related to resuscitation, these orders govern the use of restraints to prevent harm. They can be seen as complementary to DNR orders, emphasizing patient autonomy and comfort.

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

   A Do Not Resuscitate Order is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops beating or if they stop breathing. In New York, this order is designed for individuals who wish to forgo resuscitation efforts in the event of a medical emergency.

2. Who can request a DNR Order?

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

3. How is a DNR Order completed?

   To complete a DNR Order in New York, the patient or their representative must fill out a specific form provided by the state. This form must be signed by the patient and their physician. It is crucial to ensure that the form is filled out accurately to avoid any confusion during a medical emergency.

4. Where should the DNR Order be kept?

   The completed DNR Order should be kept in a location that is easily accessible to both the patient and their healthcare providers. It is advisable to keep a copy in the patient’s medical records, at home, and with any caregivers. Additionally, wearing a medical alert bracelet or necklace that indicates the presence of a DNR Order can be beneficial.

5. Can a DNR Order be revoked?

   Yes, a DNR Order can be revoked at any time by the patient or their authorized representative. To revoke the order, simply inform your healthcare provider and ensure that the DNR form is destroyed or marked as revoked. Communication with all involved parties is essential to ensure that the revocation is honored.

6. What happens if a DNR Order is not available during an emergency?

   If a DNR Order is not available when an emergency occurs, healthcare providers are required to perform CPR and other resuscitation measures. This underscores the importance of ensuring that the DNR Order is readily accessible and communicated to family members and caregivers.

7. Are there any limitations to a DNR Order?

   A DNR Order specifically applies to resuscitation efforts such as CPR. It does not affect other medical treatments or interventions. Patients can still receive other forms of medical care, including pain management and comfort measures, even with a DNR Order in place.

8. How does a DNR Order affect end-of-life care?

   A DNR Order is a critical component of end-of-life care planning. It allows individuals to express their wishes regarding resuscitation, ensuring that their preferences are respected. Having a DNR Order can facilitate discussions about other aspects of care, such as hospice or palliative care options, providing comfort and dignity during the final stages of life.

The New York Do Not Resuscitate (DNR) Order form is an important document for individuals who wish to express their preferences regarding emergency medical treatment. Alongside this form, several other documents may be used to provide comprehensive guidance on healthcare decisions. Below is a list of related forms and documents that are often utilized in conjunction with the DNR Order.

• Health Care Proxy: This document allows an individual to appoint someone they trust to make medical decisions on their behalf if they become unable to do so. It ensures that the appointed person understands the individual's wishes regarding treatment and care.
• Living Will: A living will outlines specific medical treatments and interventions an individual does or does not want in the event they are unable to communicate their preferences. This document provides clarity on end-of-life care decisions.
• Order for Life-Sustaining Treatment (OLST): This form complements the DNR Order by detailing the individual's preferences for various life-sustaining treatments, such as feeding tubes or mechanical ventilation. It serves as a comprehensive guide for healthcare providers.
• Advance Directive: An advance directive is a general term that encompasses both the living will and health care proxy. It allows individuals to specify their healthcare preferences and appoint a decision-maker, ensuring their wishes are honored.
• Transfer-on-Death Deed: The North Carolina Transfer-on-Death Deed form allows property owners to transfer their real estate to designated beneficiaries upon their death, avoiding the probate process. For more details, visit transferondeathdeedform.com/north-carolina-transfer-on-death-deed.
• Physician Orders for Life-Sustaining Treatment (POLST): Similar to the OLST, the POLST form translates the patient’s wishes into actionable medical orders. It is designed for patients with serious illnesses and provides clear instructions for emergency responders and healthcare providers.

These documents work together to ensure that an individual's healthcare preferences are respected and followed. It is essential for individuals to discuss their wishes with family members and healthcare providers to ensure clarity and understanding of their choices.