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When individuals in New York face serious health conditions, making decisions about end-of-life care becomes a pivotal aspect of the planning process. The New York Do Not Resuscitate (DNR) Order form serves as a critical tool in this journey, enabling patients to express their wishes not to receive cardiopulmonary resuscitation (CPR) in the event of a cardiac or respiratory arrest. This form, which must be filled out with the guidance of a healthcare provider, highlights the importance of autonomy in medical decision-making. Moreover, the DNR order ensures that first responders and medical personnel are aware of and can respect a patient's preferences regarding life-sustaining treatments. Understanding the specifics of this form, including how to initiate the process, the roles of healthcare providers and witnesses, and how the order can be revoked or updated, is essential for any New Yorker seeking to take control of their healthcare outcomes and ensure their end-of-life wishes are honored.
Example - New York Do Not Resuscitate Order Form
New York Do Not Resuscitate Order
This Do Not Resuscitate (DNR) order is prepared in accordance with the New York State Public Health Law Article 29-B and the Family Health Care Decisions Act (FHCDA). It serves as a legally binding document between the undersigned patient or their legally authorized representative and healthcare providers, indicating the patient's decision to refrain from receiving cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
Patient Information
Full Name: ____________________________________________________
Date of Birth: ________________ (MM/DD/YYYY)
Address: _____________________________________________________
City, State, ZIP: _____________________________________________
Telephone Number: ____________________________________________
Legal Representative Information (if applicable)
If this order is being completed on behalf of the patient by a legally authorized representative, please complete the following:
Full Name: ____________________________________________________
Relationship to Patient: _______________________________________
Address: _____________________________________________________
City, State, ZIP: _____________________________________________
Telephone Number: ____________________________________________
Do Not Resuscitate Order
By this order, I, or the legally authorized representative named above, direct all healthcare providers under relevant New York laws not to attempt cardiopulmonary resuscitation (CPR) on me, the undersigned patient, in the event my heart stops beating or if I stop breathing. This order is based on:
- My personal desire
- My medical condition, as explained by my healthcare provider
Physician or Nurse Practitioner Acknowledgment
I, the undersigned physician or nurse practitioner, certify that the patient or their legally authorized representative has discussed with me the ramifications of a Do Not Resuscitate (DNR) order. The patient, or their representative, has made an informed decision regarding the withholding of CPR. In compliance with the New York State laws, I have accordingly indicated this order in the patient’s medical record.
Physician/Nurse Practitioner Name: _______________________________
Licence Number: _____________________________________________
Signature: ___________________________ Date: _____________
Patient/Legal Representative Acknowledgment
I acknowledge that I have fully understood the nature of a Do Not Resuscitate (DNR) order, the procedures involved, and the potential consequences of this decision. I have had the opportunity to ask questions and discuss my concerns, and my decision is made freely and without any undue influence.
Signature of Patient or Legal Representative: _________________________
Date: ________________ (MM/DD/YYYY)
This document is binding across New York State and will be honored by all healthcare providers, including emergency medical personnel, in accordance with state laws. It should be reviewed periodically, especially if the patient's medical condition changes. Revisions or revocation of this order must be discussed with a healthcare provider and documented as required by New York law.
Form Specifics
| Fact | Description |
|---|---|
| Purpose | The New York Do Not Resuscitate (DNR) Order form is used to inform medical professionals not to perform CPR if a patient's breathing stops or if the patient's heart stops beating. |
| Governing Laws | This form is governed by New York State Public Health Law, Article 29-B, relating to do-not-resuscitate orders. |
| Who Can Consent | Consent can be given by the patient themselves, a healthcare proxy duly authorized by the patient, a family member, or a surrogate decision-maker as defined by New York law. |
| Form Validity | The DNR order is valid across various settings in New York, including hospitals, nursing homes, and at the patient’s home. |
| Revocation | The DNR order can be revoked at any time by the patient or their authorized representative through a written or oral statement to a healthcare provider. |
How to Write New York Do Not Resuscitate Order
The process of filling out a New York Do Not Resuscitate (DNR) Order form involves a careful sequence of steps to ensure the document accurately reflects the patient's wishes regarding life-saving treatments. This form is crucial for individuals seeking to communicate their decision not to have cardiopulmonary resuscitation (CPR) in the event their heart stops or they stop breathing. It's an important part of planning for one's health care, requiring attention to detail to accurately convey these critical preferences. The following instructions will guide you through each step of completing the form.
- Start by entering the patient's full name at the top of the form, ensuring it matches the name on their official identification to avoid any confusion regarding the document's subject.
- Fill in the patient's date of birth, using the format MM/DD/YYYY, to provide clear information on the patient's age and for identification purposes.
- Specify the patient's current address, including street address, city, state, and zip code, to ensure there is no ambiguity about the patient’s residence.
- Enter the name of the physician issuing the DNR order, which is a requirement for the form's validity. The physician must be licensed to practice in New York State.
- Include the physician's license number, a critical component for verifying the legitimacy of the DNR order and the authority of the physician to issue it.
- Document the reason for the DNR order, specifying the medical conditions or considerations that underlie the decision not to pursue resuscitative efforts.
- The patient or their legally authorized health care proxy should sign the form, providing consent to the DNR order. The date of the signature must be included, confirming when the decision was made.
- A witness, who must be an adult of sound mind, should sign the form and print their name, adding an additional layer of verification and consent to the document.
- Finally, the physician must sign and date the form, officially enacting the DNR order. The physician's signature confirms their agreement with and verification of the patient's wish to forego CPR.
After completing these steps, it is essential to keep the DNR order in an easily accessible place and to inform close family members, caregivers, and the patient’s primary physician of its existence and location. This ensures that in an emergency, the DNR order can be quickly located and respected, aligning actions with the patient’s wishes.
Things You Should Know About This Form
What is a Do Not Resuscitate Order (DNR) in New York?
A Do Not Resuscitate Order, commonly referred to as a DNR, is a medical order signed by a healthcare provider in New York. It instructs healthcare professionals not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating. It is used to respect the wishes of a patient who chooses not to undergo CPR in the event of cardiac or respiratory arrest.
Who can request a DNR order in New York?
In New York, a DNR order can be requested by any competent adult who understands the nature and consequences of their decision. This includes patients with terminal illnesses, chronic conditions, or those who feel that the quality of their life would not improve with the intervention. If the patient is not able to communicate their wishes due to their medical condition, a legally appointed guardian or a health care agent with the authority under a health care proxy can request a DNR on their behalf.
How is a DNR order implemented in New York?
To implement a DNR order in New York, a formal process must be followed. The decision is discussed between the patient (or their representative) and the healthcare provider, such as a doctor. After reaching a mutual understanding, the healthcare provider fills out the DNR form, ensuring both parties sign it. The signed document is then included in the patient’s medical records. It's important for family members or caregivers to be aware of the DNR order and its location.
Can a DNR order be revoked or canceled in New York?
Yes, a DNR order can be revoked or canceled at any time by the patient or their legally designated representative. The revocation does not require a specific form but should be communicated as clearly as possible to the healthcare provider. Following the communication, the healthcare provider will make the necessary adjustments to the patient's medical record.
What happens if there is no DNR order in place in New York?
If there is no DNR order in place, healthcare professionals in New York will proceed with all lifesaving measures, including CPR, in the event of cardiac or respiratory arrest. This standard procedure is followed to preserve life until further instructions are provided by the patient or their legal representative.
Where should a DNR order be kept?
A DNR order should be kept in a location that is easily accessible to healthcare professionals in an emergency. This often includes placing a copy in the patient’s medical records at their healthcare provider's office, as well as at their home if they receive care there. Some individuals choose to carry a DNR identification, such as a bracelet or a card, to inform emergency personnel of their DNR status.
Common mistakes
Filling out a New York Do Not Resuscitate (DNR) order form is a critical task that requires careful attention. Often, people make mistakes that could potentially render the document invalid or ineffective. One common error is not ensuring that the person signing the form has the authority to do so. This form requires a signature from the patient or their medical proxy/health care agent. If someone other than these designated individuals signs the form, it could be considered invalid.
Another mistake is failing to properly date the document. The date next to the signature is essential because it indicates when the DNR order became effective. A missing or incorrect date can cause confusion and delays in a medical emergency, potentially leading to unwanted resuscitation efforts.
Many also overlook the requirement for a physician's signature. For a DNR order to be valid in New York, it must be signed by a licensed physician who has assessed the patient's health status. Without this professional validation, the document lacks legal standing, and healthcare providers might disregard the patient's wishes.
A further error lies in not discussing the decision with family members or caregivers. While this is not a legal requirement for the form's validity, failing to communicate one's wishes can cause distress and conflict among loved ones and caregivers who are unaware of the patient's preferences regarding life-saving measures.
People often neglect to review and update the DNR order. Health conditions and personal wishes can change, so it's important to ensure that the DNR order reflects the current choices of the individual. An outdated form may not accurately convey the patient's current desires, leading to undesired medical interventions.
Another significant mistake is not making multiple copies of the signed DNR order. It's crucial to provide copies to relevant parties, such as family members, healthcare agents, and primary care doctors, to ensure that the order is easily accessible in an emergency. A sole copy that's hard to find can delay its implementation.
Finally, misunderstanding the scope of the DNR order is a common mistake. Some believe it means no medical treatment in case of an emergency, but in reality, it specifically instructs healthcare providers not to perform CPR. Patients should understand that other life-saving measures, not involving resuscitation, can still be administered unless other directives specify otherwise.
Documents used along the form
When it comes to making important health care decisions, particularly about end-of-life care, the New York Do Not Resuscitate (DNR) Order form is critical. However, it's just one piece of the puzzle. To ensure comprehensive care and respect for the patient's wishes, several other documents are often used in conjunction. These forms complement the DNR order, addressing different aspects of a patient's health care preferences.
- Health Care Proxy: This document allows a person to appoint a health care agent to make health care decisions on their behalf if they are unable to communicate their wishes. This includes decisions about accepting or refusing treatment, other than the DNR order.
- Living Will: This document outlines a person's preferences regarding the kinds of medical treatment they do or do not want to receive at the end of their life or if they are unable to speak for themselves. Unlike the DNR, which is strictly about resuscitation, a living will can address a broad range of treatments and circumstances.
- Medical Orders for Life-Sustaining Treatment (MOLST): This is a detailed form that outlines a patient’s preferences for life-sustaining treatment, including the use of ventilators, feeding tubes, and other measures. The MOLST is designed for patients with serious health conditions and complements the DNR by covering a broader scope of treatment preferences.
- Non-Hospital DNR: Specific to New York, this variant of the DNR order is for patients who are at home, in hospice, or in a nursing home. This form ensures that the patient’s wishes regarding resuscitation are respected outside of a hospital setting.
- Do Not Intubate (DNI) Order: Often used alongside the DNR order, this form indicates a patient’s wish to avoid intubation and mechanical ventilation. Like the DNR, a DNI is crucial for avoiding specific life-sustaining treatments that a patient may not want.
In summary, navigating end-of-life decisions involves much more than a single document. The New York DNR order plays a vital role, but it's often part of a broader suite of documents. Each serves a unique purpose, ensuring that a patient's healthcare preferences are understood and respected across different scenarios. Together, these forms help patients, families, and healthcare providers make informed decisions aligned with the patient's wishes.
Similar forms
The New York Do Not Resuscitate (DNR) Order form shares similarities with a Living Will. Both documents concern a person's preferences regarding medical treatments at the end of their life. While a DNR specifically instructs healthcare providers not to perform CPR or advanced cardiac life support if a patient's breathing or heart stops, a Living Will is broader. It can include directives about the use of ventilators, feeding tubes, and other life-sustaining treatments besides CPR.
Similar to the DNR, a Medical Power of Attorney (MPOA) plays a critical role in healthcare decisions. However, the MPOA designates a person, known as a healthcare proxy or agent, to make healthcare decisions on behalf of the individual if they are unable to communicate their wishes. This may include decisions about resuscitation as outlined in a DNR order, but it extends to other medical treatments and interventions as well.
The Physician Orders for Life-Sustaining Treatment (POLST) form is another document akin to a DNR. While both serve the purpose of guiding healthcare providers on the patient's preferences for end-of-life care, the POLST form is more comprehensive. It covers a range of treatments beyond CPR, like antibiotic use, feeding tubes, and mechanical ventilation, based on detailed discussions between the patient and the physician. This makes the POLST suitable for individuals with serious health conditions, ensuring their treatment preferences are respected across different healthcare settings.
An Advance Directive is a broader term that encompasses various types of healthcare directives, including Living Wills and DNR orders. It is a legal document through which individuals outline their healthcare preferences should they become incapacitated. While a DNR specifically focuses on the refusal of CPR or advanced cardiac interventions, Advance Directives provide a comprehensive overview of one's treatment preferences, including the appointment of a healthcare proxy, specific medical treatments one does or does not want, and decisions about organ donation.
Dos and Don'ts
When it comes time to fill out the New York Do Not Resuscitate (DNR) Order form, it's important to proceed with care and diligence. This document is crucial for ensuring that a person's end-of-life care wishes are respected. To help guide you through this sensitive process, here's a comprehensive list of dos and don'ts:
- Do ensure that the patient or their legally authorized representative is directly involved in the decision-making process. It’s vital that this choice reflects the wishes of the person it concerns.
- Don't rush through the form without fully understanding each section. Take the time to read and comprehend every part of the document to ensure that all information is accurately provided.
- Do consult with a healthcare provider if you have any questions or concerns. Medical professionals can offer valuable insights and explain the implications of a DNR order.
- Don't leave any sections incomplete. Every part of the form is important for its validity and effectiveness. Omitting information can lead to misunderstandings or enforcement issues.
- Do ensure that the form is properly signed and dated. Without the necessary signatures, the DNR order may not be legally recognized.
- Don't forget to make copies of the completed form. Keep a copy for your records and distribute others to relevant parties, such as family members and healthcare providers, to ensure that the patient's wishes are honored.
Filling out the New York DNR Order form is an important step in planning for compassionate and respectful end-of-life care. By following these guidelines, you can help ensure that the process is done correctly and that the patient's health care preferences are clearly communicated and respected.
Misconceptions
Many people have misunderstandings about the New York Do Not Resuscitate (DNR) Order form. Here are four common misconceptions that need clarification:
Only the patient can request a DNR order. This is not entirely true. If a patient is unable to make their own healthcare decisions, a healthcare agent or a family member can consent to a DNR order on their behalf, guided by the patient’s known wishes or best interests.
A DNR order applies to all medical treatments. This is a misconception. A DNR specifically instructs medical personnel not to initiate CPR (cardiopulmonary resuscitation) if a patient’s breathing stops or if the heart stops beating. It does not impact other forms of medical care that a patient might receive.
Having a DNR means you cannot be admitted to the hospital. This is false. A DNR order solely advises against the use of CPR. It does not restrict other medical treatments, including hospitalization if necessary for the patient’s health condition. The focus is on the quality of life and respecting the patient’s wishes regarding resuscitation.
A DNR order is permanent and irreversible. In reality, a DNR order can be revoked or modified at any time by the patient or their legally appointed healthcare agent. It’s essential for ongoing discussions about end-of-life care preferences to take place, ensuring that the DNR order reflects the current wishes of the patient.
Understanding the specifics of a DNR order can empower individuals and families to make informed decisions that align with their values and wishes regarding healthcare and end-of-life care.
Key takeaways
The New York Do Not Resuscitate (DNR) Order form is a critical document for those who choose not to receive cardiopulmonary resuscitation (CPR) in the event their heart stops or they stop breathing. Understanding how to properly fill out and use this form is essential for ensuring that a person's wishes are respected. Here are some key takeaways about the process:
- Before filling out the DNR form, a conversation with a healthcare provider is necessary to fully understand the implications. This ensures that the decision is made based on a clear understanding of what CPR entails and the situations it would be applied.
- The person's current health status and personal beliefs about end-of-life care should guide the decision to complete a DNR order.
- A DNR order must be signed by both the individual (or their health care proxy or legal guardian if the individual is unable to make decisions) and the authorized healthcare provider to be valid.
- Clearly indicate the individual's wish to not receive CPR on the form to avoid any confusion in an emergency situation. Specific conditions under which the DNR order applies should be discussed and documented.
- The DNR order should be kept in a location that is easily accessible to family members and caregivers, so it can be quickly presented to emergency medical personnel.
- If the individual resides in a healthcare facility, the DNR order should be included in their medical record and be readily available to all healthcare staff involved in the person's care.
- An individual can change their mind and revoke the DNR order at any time. This decision should be communicated immediately to the healthcare provider, and all copies of the old DNR form should be destroyed.
- Be aware of New York state laws and regulations regarding DNR orders, as they guide how these orders are implemented and respected by healthcare professionals and emergency personnel.
Understanding these key points ensures that individuals can make informed choices about their end-of-life care, and that these wishes are clearly communicated and respected by all parties involved.
Other Popular Do Not Resuscitate Order State Forms
Can Family Override Dnr - The document serves as a critical tool in patient autonomy, allowing individuals to control the extent of medical intervention they receive.
What Is a Dnr in Medical Terms - Part of comprehensive end-of-life care planning, including considerations about pain management, comfort, and support services.
Polst Form Utah - A Do Not Resuscitate Order must be signed by both the patient and their healthcare provider to be considered valid.
Dnr and Dni Documents Are All Part of What Are Known as - Through its use, the form addresses ethical dilemmas that arise when life-sustaining treatments may prolong suffering without adding to the quality or duration of life.