Free Do Not Resuscitate Order Form for the State of New York

1. Not including the patient's full name: It's essential to write the complete name of the patient on the form. Omitting this detail can lead to confusion and invalidation of the order.

2. Failing to sign the form: The form must be signed by the patient or their legal representative. Without a signature, the order is not legally binding.

3. Not dating the form: Always include the date when the form is filled out. This helps establish when the order was created and ensures it reflects the patient's current wishes.

4. Using incorrect or outdated forms: Make sure to use the most current version of the New York Do Not Resuscitate Order form. Older versions may not be accepted by healthcare providers.

5. Not discussing the order with healthcare providers: Communication is key. Discussing the order with doctors and nurses ensures everyone understands the patient's wishes.

6. Neglecting to inform family members: It's important to share the decision with family members. They should be aware of the patient's wishes to avoid confusion during emergencies.

7. Leaving out necessary medical information: Providing relevant medical history or conditions can help clarify the need for the Do Not Resuscitate order.

8. Not reviewing the order regularly: Life circumstances change. Regularly reviewing the order ensures it still aligns with the patient’s current wishes.

When considering the New York Do Not Resuscitate (DNR) Order form, it is essential to understand its significance and how to properly complete it. Here are some key takeaways:

• Understanding the Purpose: A DNR order is a medical directive that indicates a person's wish not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. This document is crucial for ensuring that a person's end-of-life preferences are respected.
• Eligibility: Any adult can complete a DNR order, but it must be signed by a physician to be valid. It is advisable to discuss this decision with healthcare providers to ensure that it aligns with medical advice and personal wishes.
• Proper Completion: The form requires specific information, including the patient’s name, date of birth, and signature, as well as the physician's signature and date. Accuracy is vital to avoid any confusion during a medical emergency.
• Communication: Once the DNR order is completed, it should be communicated to family members and healthcare providers. Keeping a copy readily available, such as in a medical file or with a caregiver, ensures that it can be easily accessed when needed.

When filling out the New York Do Not Resuscitate (DNR) Order form, it's essential to approach the process with care and attention. Here are some important dos and don'ts to keep in mind:

• Do ensure that you understand the implications of a DNR order before completing the form.
• Do discuss your wishes with your healthcare provider and family members.
• Do fill out the form completely and accurately, providing all required information.
• Do sign and date the form in the appropriate sections.
• Do keep a copy of the completed form for your records.

• Don't leave any sections of the form blank, as this may cause confusion or delays.
• Don't assume that verbal instructions are enough; always have a written order.
• Don't forget to inform your healthcare team that you have a DNR order in place.
• Don't neglect to review and update the form if your wishes change over time.

By following these guidelines, you can ensure that your DNR order accurately reflects your wishes and is properly documented. This can provide peace of mind for both you and your loved ones.

Understanding the New York Do Not Resuscitate (DNR) Order form can be challenging. Many people hold misconceptions about what this document entails and how it operates. Here are seven common misconceptions clarified:

1. A DNR means no medical care at all.

   This is not true. A DNR specifically addresses resuscitation efforts in the event of cardiac arrest. Other medical treatments can still be provided, including pain management and comfort care.

2. Only terminally ill patients need a DNR.

   While many individuals with terminal conditions choose to have a DNR, anyone can request one. It is a personal decision based on individual values and preferences regarding end-of-life care.

3. A DNR is permanent and cannot be changed.

   This misconception is incorrect. A DNR can be revoked or modified at any time by the patient or their healthcare proxy. It is important to communicate any changes to your healthcare providers.

4. Having a DNR means you will not receive care in a hospital.

   This is misleading. Hospitals will provide necessary medical care, except for resuscitation efforts. Other treatments will continue as needed, ensuring patient comfort and safety.

5. A DNR must be notarized to be valid.

   In New York, a DNR does not require notarization. It must be properly signed by the patient or their healthcare proxy and a physician, but notarization is not necessary.

6. All medical staff will know about your DNR.

   This is not guaranteed. It is crucial to ensure that your DNR form is placed in your medical records and that your healthcare team is informed about your wishes.

7. A DNR is only for elderly individuals.

   This is a misconception. People of all ages can have a DNR if they choose. It is about individual preferences and discussions with healthcare providers, not just age.

By addressing these misconceptions, individuals can make informed decisions regarding their healthcare preferences. Understanding the DNR process is essential for ensuring that your wishes are respected in critical situations.

A Do Not Resuscitate (DNR) Order is an important document that allows individuals to express their wishes regarding resuscitation efforts in case of a medical emergency. Alongside the DNR form, several other documents can help ensure that a person's healthcare preferences are respected. Below is a list of common forms and documents often used in conjunction with a New York DNR Order.

• Health Care Proxy: This document designates someone to make medical decisions on behalf of an individual if they become unable to communicate their wishes. It empowers a trusted person to act in the best interest of the patient.
• Living Will: A living will outlines a person's preferences for medical treatment in situations where they are unable to express their wishes. It typically addresses end-of-life care, including the use of life-sustaining treatments.
• Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that specifies the types of medical treatment a patient wishes to receive during a medical emergency. It is designed for individuals with serious illnesses and is signed by a healthcare provider.
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• Do Not Intubate (DNI) Order: Similar to a DNR, a DNI order specifically indicates that a patient does not wish to be intubated or placed on a ventilator. This document is crucial for patients who want to avoid invasive breathing support.
• Advanced Care Plan: This document provides a comprehensive overview of a person's healthcare preferences, including treatment goals and values. It helps guide healthcare providers and family members in making decisions aligned with the individual's wishes.
• Emergency Medical Services (EMS) Directive: This directive informs emergency responders of a patient's wishes regarding resuscitation and other emergency interventions. It is often carried in a wallet or on a medical alert bracelet.
• Durable Power of Attorney for Health Care: This document grants authority to an individual to make healthcare decisions on behalf of another person. It remains effective even if the person becomes incapacitated.

Each of these documents plays a vital role in ensuring that a person's healthcare preferences are honored, especially during critical moments. By understanding and utilizing these forms, individuals can create a clear and comprehensive plan for their medical care.

• Advance Healthcare Directive: This document allows individuals to outline their preferences for medical treatment in the event they become unable to communicate. Like a Do Not Resuscitate Order, it provides guidance to healthcare providers about the patient's wishes.
• Living Will: A living will specifies the types of medical treatment a person wishes to receive or avoid at the end of life. Similar to a DNR, it serves to inform medical personnel about the individual's desires regarding life-sustaining measures.
• Durable Power of Attorney for Healthcare: This document designates a trusted person to make healthcare decisions on behalf of an individual if they are incapacitated. It complements a DNR by ensuring that someone can advocate for the patient's wishes regarding resuscitation and other treatments.
• Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that outlines a patient's preferences for treatments like resuscitation and intubation. It is similar to a DNR in that it provides specific instructions for emergency personnel and healthcare providers.
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• Do Not Intubate (DNI) Order: A DNI order specifically instructs healthcare providers not to insert a breathing tube if a patient stops breathing. This document aligns closely with a DNR by focusing on the patient's preferences regarding specific life-saving interventions.
• Emergency Medical Services (EMS) Do Not Resuscitate (DNR) Bracelet: This bracelet serves as a visible indicator of a person's DNR status, alerting emergency responders to the patient's wishes in critical situations. It functions similarly to a DNR order by communicating the individual's intent regarding resuscitation.

Detailed Instructions for Writing New York Do Not Resuscitate Order

Completing the New York Do Not Resuscitate Order form is an important step for individuals who wish to express their preferences regarding medical treatment in emergencies. Follow these steps to ensure the form is filled out correctly.

1. Obtain the New York Do Not Resuscitate Order form. You can find it online or request it from a healthcare provider.
2. Fill in your personal information at the top of the form. This includes your full name, date of birth, and address.
3. Designate a healthcare proxy if you have one. This person will make medical decisions on your behalf if you cannot do so.
4. Clearly indicate your wishes regarding resuscitation. There will be a section where you can mark your preference.
5. Sign and date the form. Your signature is essential for it to be valid.
6. Have the form witnessed. Two witnesses must sign the form, confirming they saw you sign it.
7. Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and proxy.

Once the form is completed, it is crucial to discuss your wishes with your healthcare team and loved ones. This ensures everyone is aware of your preferences and can act accordingly in case of a medical emergency.