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New York Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order is created in accordance with New York State Public Health Law, Article 29-B.

Please fill in the required information below:

  • Patient's Full Name: ____________________________________________
  • Date of Birth: ________________________________________________
  • Address: ____________________________________________________
  • Phone Number: ________________________________________________
  • Medical Record Number: _____________________________________

Physician's Information:

  • Physician's Name: ____________________________________________
  • License Number: ______________________________________________
  • Practice Name: _______________________________________________
  • Contact Number: _____________________________________________

DNR Directives:

  1. This order prohibits the use of cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
  2. It applies to all healthcare workers and facilities providing treatment to the patient.
  3. This document should be displayed prominently in the patient's medical file.

Signature: _________________________________________

Date: _____________________________________________

This Do Not Resuscitate Order must be reviewed and signed by a physician to be effective.

Common mistakes

Filling out the New York Do Not Resuscitate (DNR) Order form is an important decision that can significantly impact a person's end-of-life care. However, many individuals make common mistakes when completing this document. Understanding these pitfalls can help ensure that your wishes are accurately represented.

One frequent error is failing to provide clear and specific instructions. The DNR form requires precise language to avoid confusion among medical personnel. Vague statements can lead to misunderstandings about a patient's wishes. Always be explicit about your preferences to ensure they are honored.

Another mistake is neglecting to sign the form properly. A valid DNR order must be signed by the patient or their legally authorized representative. Without a signature, the document holds no legal weight. Double-check that all required signatures are present before submitting the form.

People often overlook the necessity of having the DNR order witnessed. In New York, the law requires that the form be signed in the presence of at least one witness. This witness must also sign the form. Skipping this step can invalidate the order and leave healthcare providers unsure of the patient's wishes.

Additionally, individuals sometimes forget to provide copies of the completed DNR form to their healthcare providers. After filling out the form, it’s crucial to distribute copies to your doctors and any medical facilities you frequent. This ensures that your wishes are known and respected in emergency situations.

Lastly, failing to review and update the DNR order can lead to complications. Life circumstances change, and so can a person's wishes regarding medical treatment. Regularly revisiting the DNR form ensures that it reflects your current preferences. This simple step can prevent confusion and ensure that your healthcare aligns with your values.

Dos and Don'ts

When filling out the New York Do Not Resuscitate Order form, it is essential to follow specific guidelines to ensure that your wishes are respected. Here is a list of things you should and shouldn't do:

  • Do ensure that you understand the implications of a Do Not Resuscitate Order.
  • Do consult with your healthcare provider before completing the form.
  • Do sign and date the form in the presence of a witness.
  • Do provide copies of the completed form to your healthcare proxy and family members.
  • Do keep the form in an accessible location, such as your medical records or with your healthcare provider.
  • Don't fill out the form under pressure or without full understanding.
  • Don't forget to review the form periodically to ensure it reflects your current wishes.
  • Don't assume that verbal instructions are sufficient; always use the official form.
  • Don't neglect to inform emergency medical personnel about your DNR status.
  • Don't leave the form unsigned or undated, as it may not be considered valid.
⇓ PDF

Other Do Not Resuscitate Order State Forms

Illinois Do Not Resuscitate - A DNR does not affect other medical treatments or wishes.

To gain further insights into the mechanics and importance of a Hold Harmless Agreement, you can visit TopTemplates.info, which provides valuable resources and templates that ensure you understand the nuances of these agreements and how they can be tailored to your specific needs.

Dnr Hospital - Enables healthcare facilities to prepare for patient-centered care tailored to individual wishes.

Texas Dnr Form - Patients who do not wish for resuscitation can use this order to inform medical staff of their decision.

Similar forms

A Do Not Resuscitate (DNR) Order is a critical document in healthcare, indicating a patient’s wish to forgo resuscitation efforts in the event of cardiac arrest or respiratory failure. Several other documents serve similar purposes, often focusing on patient autonomy and end-of-life care. Here’s a look at ten documents that share similarities with a DNR Order:

  • Advance Directive: This document outlines a person's preferences for medical treatment and interventions when they are unable to communicate their wishes. Like a DNR, it emphasizes patient autonomy in healthcare decisions.
  • Living Will: A living will specifically addresses a person's desires regarding life-sustaining treatments. It often complements a DNR by detailing what types of medical care a person does or does not want.
  • Healthcare Proxy: This legal document designates an individual to make healthcare decisions on behalf of the patient if they become incapacitated. It works alongside a DNR to ensure that a patient's wishes are honored.
  • POLST (Physician Orders for Life-Sustaining Treatment): A POLST form provides medical orders for specific treatments, including resuscitation, and is often used for patients with serious illnesses. It is more detailed than a DNR and is intended for immediate medical use.
  • Do Not Intubate (DNI) Order: A DNI order specifies that a patient should not be intubated in the event of respiratory failure. It is similar to a DNR in that it limits certain medical interventions.
  • Comfort Care Order: This document focuses on providing comfort rather than curative treatment. It aligns with the principles of a DNR by prioritizing quality of life over aggressive medical interventions.
  • Patient Bill of Rights: This document outlines the rights of patients regarding their medical care, including the right to refuse treatment. It supports the philosophy behind a DNR by empowering patients to make informed choices.
  • General Power of Attorney: This legal form provides individuals with the ability to appoint an agent for financial and property decisions when they are unable to act. For comprehensive information, refer to our detailed guide on General Power of Attorney.
  • End-of-Life Care Plan: This comprehensive plan addresses various aspects of a patient’s care at the end of life, including pain management and emotional support, complementing the decisions made in a DNR.
  • Do Not Hospitalize (DNH) Order: A DNH order indicates that a patient should not be admitted to a hospital for treatment. It reflects similar values to a DNR by prioritizing the patient's preferences for care.
  • Medical Power of Attorney: This document allows a person to appoint someone else to make medical decisions on their behalf. It reinforces the intent of a DNR by ensuring that someone trusted can advocate for the patient's wishes.

Each of these documents plays a vital role in ensuring that patients' wishes are respected and that their rights are upheld in the face of medical decisions, particularly at critical junctures in their care.