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Legal Do Not Resuscitate Order Template for New York State

A New York Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of cardiac arrest or respiratory failure. This form ensures that medical personnel respect the patient's preferences for end-of-life care. Understanding its significance can help individuals make informed decisions about their healthcare choices.

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Other Common Do Not Resuscitate Order State Templates

Dnr Paperwork - Informed consent applies to DNR orders, meaning patients should fully understand the implications before signing.

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Example - New York Do Not Resuscitate Order Form

New York Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is executed in accordance with New York State law regarding advance directives and healthcare decision-making. This is a legal document that indicates an individual's choice to forgo resuscitation efforts in the event of cardiac arrest or respiratory failure.

Patient Information:

Name: _______________________
Date of Birth: ________________
Address: ______________________
Phone Number: ________________

Physician Information:

Physician Name: ________________
Physician License Number: ___________
Contact Number: ________________

This order is valid only when signed by both the patient (or a legally authorized representative) and a licensed physician.

Signatures:

Patient or Authorized Representative Signature: ________________
Date: ________________
Physician Signature: ________________
Date: ________________

Please ensure that copies of this DNR Order are distributed to healthcare providers involved in your care, as well as kept in an easily accessible location.

By initiating this DNR Order, you may be ensuring your wishes are respected during critical medical situations. It is recommended to discuss this decision with healthcare professionals to understand all implications.

Documents used along the form

When considering end-of-life care preferences in New York, a Do Not Resuscitate (DNR) Order is just one important document. Several other forms can complement a DNR to ensure that an individual’s healthcare wishes are respected. Below is a list of commonly used documents that may accompany a DNR Order.

Healthcare Proxy: This document designates a specific person to make medical decisions on behalf of an individual if they become unable to do so. It empowers the proxy to act in accordance with the individual's wishes.
Living Will: A living will outlines an individual's preferences regarding medical treatment in situations where they cannot communicate their wishes. It typically addresses life-sustaining treatments and other critical healthcare decisions.
Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that outlines a patient’s preferences for treatment in emergency situations. It is designed for individuals with serious illnesses and complements the DNR Order.
Advance Care Plan: This is a broader document that includes both the living will and healthcare proxy. It serves as a comprehensive guide to an individual’s healthcare preferences and goals.
California Residential Lease Agreement: This document outlines the terms and conditions for renting a residential property. To fill out the form, visit California PDF Forms.
Patient Information Form: This form collects essential information about a patient’s medical history, current medications, and allergies. It helps healthcare providers make informed decisions about treatment.
Do Not Hospitalize Order: This order specifies that a patient should not be admitted to a hospital for treatment. It is often used for patients in hospice care or those with terminal conditions.
Comfort Care Order: This document outlines the type of care a patient wishes to receive to maintain comfort and dignity, focusing on pain relief rather than curative treatment.
Organ Donation Consent: This form indicates an individual’s wishes regarding organ donation after death. It ensures that healthcare providers are aware of the individual’s intentions.

Each of these documents plays a vital role in ensuring that healthcare providers and loved ones understand and respect an individual’s wishes regarding medical treatment and end-of-life care. It is essential to have these forms prepared and discussed with family members and healthcare professionals to facilitate clear communication during critical moments.