Do Not Resuscitate (DNR) New York (and it’s alternative – MOLST)

Document Name
“Out of Hospital DNR” or Medical Order for Life-Sustaining Treatment (MOLST)
Where do you get the form
Any licensed physician should have a blank DNR Order or a MOLST form. If you need to provide a form to your physician, you can get one from the NY state website.  You can find the links below.

Who is permitted to request a DNR order for themselves

All adult patients can request a DNR order.

Who signs the form

The physician and the patient consent to a DNR order in writing.  However, only the physician actually signs the DNR form.  Both the physician and the patient sign the MOLST form.

Patient Identification
New York EMS will honor the DNR Order form, a standard DNR bracelet or a properly executed MOLST form.
How do you obtain a DNR bracelet
New York state has not approved a specific vendor.  They suggest that once the DNR form is signed, you can obtain a bracelet from Medic Alert.  Medic Alert or Appomattox Drug Store.    Since the only specific requirements are that it is a standard metal bracelet which includes a caduceus and the words “DO Not Resuscitate”, you can probably find the bracelet at other companies as well.
Revoking a DNR or a MOLST
You, or anyone who consents to a DNR or MOLST order on your behalf, can remove the order by telling doctors, nurses or others about the decision. This need not be done in writing. Once informed of your wishes, your physician must record the revocation in your chart, cancel the order and make diligent efforts to retrieve all copies of your executed form, as well as your DNR bracelet if applicable.
Photocopy
An original DNR form is printed in black ink on white paper.  A MOLST form is usually printed on bright pink paper.  A photocopy of either is recognized as an authentic DNR form.
State info link
http://www.health.ny.gov/professionals/ems/policy/99-10.htm

Other link
http://tinyurl.com/djekqu
http://www.health.ny.gov/forms/doh-5003.pdf
http://www.vialoflife.com/
DNR Bracelet links
DNR bracelets may be obtained from most companies that sell medical identification bracelets, provided they have a copy of your New York DNR form (DOH-3474) on file. Some bracelet sources include:

  • Appomattox Drug Store, PO Box 489, Appomattox, VA 24522. Telephone 1-800-330-7225 ex. 102, or order on-line at http://tinyurl.com/cf5jdq
  • Medic Alert Foundation International, Attn DNR, 2323 Colorado Avenue, Turlock, CA 95382 Phone: 1-888-633-4298, 3, 1 or ask for DNR. http://tinyurl.com/dlkluh

Medical Identification Jewelry (on-line orders only) at http://tinyurl.com/dk3yun or http://tinyurl.com/cs983u

Special Notes
Order a Vial of Life decal for your front door. The decal informs Emergency Medical Services team a DNR has been prepared and can be found in your refrigerator.

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