Fast PDF Templates
Homepage / Fillable Do Not Resuscitate Order Document / Attorney-Approved New York Do Not Resuscitate Order Document

Attorney-Approved New York Do Not Resuscitate Order Document

Access Document
Structure

Misconceptions

Many people have misunderstandings about the New York Do Not Resuscitate (DNR) Order form. It's crucial to clarify these misconceptions to ensure that individuals make informed decisions about their healthcare. Below are nine common misconceptions:

  1. A DNR order means I will not receive any medical care. This is false. A DNR order specifically pertains to resuscitation efforts, such as CPR. Other medical treatments will still be provided.
  2. Only terminally ill patients can have a DNR order. This is incorrect. Anyone can request a DNR order, regardless of their health status, if they wish to avoid resuscitation.
  3. A DNR order is permanent and cannot be changed. This is not true. Individuals can change or revoke a DNR order at any time, as long as they are competent to do so.
  4. I need a lawyer to complete a DNR order. This is misleading. While legal advice can be helpful, a DNR order can typically be completed by a healthcare provider and does not require legal assistance.
  5. Once I have a DNR order, my family cannot intervene. This is false. Family members can still discuss and advocate for care options, even with a DNR order in place.
  6. A DNR order is only valid in hospitals. This is incorrect. A DNR order is valid in any healthcare setting, including at home or in nursing facilities, as long as it is properly documented.
  7. I cannot have a DNR order if I am not in a hospital. This is misleading. You can have a DNR order outside of a hospital, but it must be properly documented and recognized by healthcare providers.
  8. A DNR order guarantees a peaceful death. This is not necessarily true. While a DNR order prevents resuscitation, it does not guarantee that death will be without discomfort or distress.
  9. Healthcare providers will not respect my DNR order. This is false. Healthcare providers are legally obligated to honor a valid DNR order as long as it is properly executed.

Understanding these points can help individuals make informed choices about their end-of-life care. Always consult with healthcare professionals when considering a DNR order.

Detailed Steps for Filling Out New York Do Not Resuscitate Order

Filling out the New York Do Not Resuscitate Order form is an important step in expressing your medical preferences. Once completed, this document will guide healthcare providers in respecting your wishes regarding resuscitation efforts. Here’s how to complete the form effectively.

  1. Obtain the New York Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
  2. Fill in your full name, date of birth, and address in the designated sections of the form.
  3. Indicate whether you are the patient or if you are completing the form on behalf of someone else.
  4. Provide the name of the physician who is responsible for your care. This should be someone familiar with your medical history.
  5. Clearly state your wishes regarding resuscitation by checking the appropriate box on the form.
  6. Sign and date the form to validate your preferences. If someone else is signing on your behalf, ensure they include their relationship to you.
  7. Have the form witnessed by two individuals who are not related to you and who do not stand to benefit from your estate.
  8. Keep a copy of the completed form for your records and provide copies to your healthcare provider and any family members involved in your care.

Document Preview

New York Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is created in accordance with New York State Public Health Law.

Patient Information:

  • Patient Name: ______________________
  • Date of Birth: ______________________
  • Address: __________________________
  • Patient's Healthcare Proxy (if applicable): ______________________

Physician Information:

  • Physician's Name: ______________________
  • Physician's License Number: ______________________
  • Hospital/Practice Name: ______________________
  • Contact Number: ______________________

Patient's Wishes:

The patient has expressed the wish not to receive cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) in the event of cardiac or respiratory arrest.

This DNR Order is made with the understanding that:

  • This order will be honored by all healthcare providers.
  • It applies in emergency situations when the patient is unable to communicate their wishes.
  • Family members and loved ones have been informed of this decision.

Signatures:

By signing this document, I confirm that this Do Not Resuscitate Order reflects the patient's wishes:

  • Patient's Signature: ______________________
  • Date: ______________________
  • Physician's Signature: ______________________
  • Date: ______________________

This Do Not Resuscitate Order should be kept in a visible location in the patient's medical records and presented during emergencies.

Some Other Do Not Resuscitate Order State Templates

Do Not Resuscitate Form Texas - Signing a DNR means that you choose to forgo aggressive life-saving measures in certain medical situations.

Michigan Dnr Form - Creating a DNR can be a part of a broader conversation about healthcare preferences.

Dos and Don'ts

When filling out the New York Do Not Resuscitate Order form, it's important to follow some guidelines. Here are six things to keep in mind:

  • Do ensure that you understand the implications of the order.
  • Do consult with your healthcare provider before completing the form.
  • Do keep a copy of the completed form for your records.
  • Don't rush through the process; take your time to consider your decisions.
  • Don't forget to discuss your wishes with family members.
  • Don't leave the form unsigned; make sure all required signatures are in place.

Key takeaways

Filling out a Do Not Resuscitate (DNR) Order form in New York can be a crucial step in ensuring your healthcare wishes are honored. Here are some key takeaways to keep in mind:

  1. Understand the Purpose: A DNR order communicates your preference not to receive cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest.
  2. Eligibility: Anyone can request a DNR order, but it’s typically used by individuals with serious illnesses or those nearing the end of life.
  3. Consult Your Healthcare Provider: Before filling out the form, discuss your wishes with your doctor. They can provide valuable insight into the implications of a DNR order.
  4. Complete the Form Accurately: Ensure all required fields are filled out clearly. Mistakes or omissions can lead to confusion during a medical emergency.
  5. Signature Requirements: The form must be signed by you and your healthcare provider. If you’re unable to sign, a legally authorized representative can do so on your behalf.
  6. Keep Copies Accessible: After completing the form, make several copies. Share them with your healthcare team, family, and anyone else involved in your care.
  7. Review Regularly: Your health situation may change over time. Periodically review your DNR order to ensure it still reflects your wishes.
  8. Educate Your Loved Ones: Make sure your family members understand what a DNR order means and why you have chosen this option. Open communication can prevent misunderstandings.
  9. Know Your Rights: You have the right to change or revoke your DNR order at any time. Just ensure that your healthcare provider and family are informed of any changes.

By keeping these takeaways in mind, you can ensure that your DNR order is filled out correctly and that your wishes are respected in times of need.

Similar forms

The Advance Directive is a crucial document that outlines a person’s healthcare preferences in case they become unable to communicate their wishes. Like the New York Do Not Resuscitate Order (DNR), it allows individuals to express their desires regarding medical treatment, including life-sustaining measures. An Advance Directive typically includes both a living will and a healthcare proxy, providing a comprehensive view of a person’s healthcare choices. This document ensures that medical professionals and family members understand and respect the individual’s wishes, just as a DNR does specifically regarding resuscitation efforts.

The Physician Orders for Life-Sustaining Treatment (POLST) form is another important document that works alongside the DNR. POLST is designed for individuals with serious health conditions and translates their treatment preferences into actionable medical orders. While the DNR specifically addresses resuscitation, the POLST form covers a broader range of medical interventions, such as hospitalization and artificial nutrition. Both documents aim to communicate a patient’s wishes clearly, but POLST provides more detailed guidance for emergency responders and healthcare providers.

A Living Will is similar to the DNR in that it expresses an individual’s wishes regarding end-of-life care. This document specifically outlines what types of medical treatments a person does or does not want if they are terminally ill or in a persistent vegetative state. While a DNR focuses on resuscitation efforts, a Living Will can address other critical decisions, such as pain management and life support. Both documents serve to ensure that a person’s preferences are honored when they can no longer voice them.

The Healthcare Proxy is a document that designates someone to make medical decisions on behalf of an individual if they become incapacitated. This is similar to the DNR in that it emphasizes the importance of respecting a person's healthcare choices. While the DNR specifies preferences about resuscitation, the Healthcare Proxy allows a trusted person to make decisions based on the individual’s values and wishes. Together, these documents create a framework for ensuring that healthcare decisions align with what the individual would want.

The Do Not Hospitalize (DNH) order is another document that aligns with the intentions of the DNR. This order is used to indicate that a person does not wish to be admitted to a hospital under certain circumstances, particularly for individuals with terminal illnesses or advanced age. Like the DNR, the DNH emphasizes the importance of comfort and quality of life over aggressive medical interventions. Both documents are designed to guide healthcare providers in respecting patients' wishes and avoiding unnecessary procedures that may not align with their values.

Documents used along the form

A Do Not Resuscitate (DNR) Order is an important document that outlines a person's wishes regarding medical treatment in emergencies. Alongside this form, several other documents can help clarify healthcare preferences and ensure that a person's wishes are respected. Here are five commonly used forms related to end-of-life care and medical decision-making.

  • Healthcare Proxy: This document allows a person to appoint someone they trust to make medical decisions on their behalf if they become unable to do so. It is crucial for ensuring that a person's healthcare preferences are honored.
  • Living Will: A living will outlines specific medical treatments a person does or does not want in situations where they cannot communicate their wishes. It provides guidance to healthcare providers and family members.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that specifies a patient's preferences for life-sustaining treatments. Unlike a DNR, a POLST can address a broader range of medical interventions.
  • Advance Directive: An advance directive is a general term that encompasses both living wills and healthcare proxies. It allows individuals to express their wishes about medical treatment and designate someone to make decisions for them.
  • Do Not Intubate (DNI) Order: This order specifies that a person does not wish to be placed on a ventilator if they are unable to breathe on their own. It is often used in conjunction with a DNR order to clarify the level of care desired.

Understanding these documents can help individuals and families navigate difficult healthcare decisions. Having clear directives in place ensures that everyone involved knows and respects the person's wishes regarding medical treatment.