- Document Name
- Comfort Care/Do Not Resuscitate Order Verification
OR
Custom Care/Do Not Resuscitate Order Verification With Bracelet - Where do you get the form
- A physician must complete a DNR form on your behalf. If you want to order a bracelet, the physician will complete the DNR Order Verification With Bracelet form.
If your physician does not have a form, click here:
http://tinyurl.com/c627vx. - Who signs the form
- The form is signed by the physician, the patient, and two witnesses. The DNR Verification with Bracelet form must be printed on 8 1/2 inch by 14 inch legal size paper.
- Patient Identification
- The Comfort Care/DNR verification is the only document that EMS personnel can use to verify a DNR order is valid.
- How do you obtain a DNR bracelet
- Your physician must order a DNR bracelet for you.
- Revoking a DNR
- An EMS/DNR Order may be revoked at any time by the patient’s request for resuscitation made directly to responding emergency medical services personnel OR by the physical cancellation or destruction of all EMS/DNR Order forms, bracelets, and necklaces with the consent of the patient or the authorized decision maker signing the EMS/DNR Order. Destruction of an EMS/DNR Order, bracelet, or necklaces without consent carries penalties under the Health Care Decision Act.
- Photocopy
- Photocopies of the form or the bracelet inserts are not considered authentic DNR documents. If you need a document at more than one location, create multiple original documents.
- State info link
- http://tinyurl.com/c627vx
- Other links
- http://www.vialoflife.com/
- DNR Bracelet links
- Your physician must order a DNR braclet on your behalf.
- 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. The Customer Care/Do Not Resuscitate Order Verification assumes the patient has completed a separate DNR form. The DNR Order Verification form provides a way to document the existence of a DNR in out of hospital situations.
Tagged as: DNR bracelet, DNR form, DNR Order, do not resuscitate (DNR), do not resusicate, Massachusetts DNR
- Document Name:
- “Do Not Resuscitate Comfort Care Order ” OR ” Do Not Resuscitate Comfort Care Order-Arrest Order”
- Where do you get the form
- A physician, a certified nurse practitioner or a clinical nurse specialist can complete the form. If you need to provide a form to your physician, click here
- Who signs the form
- The physician and the patient can consent to a DNR order.
- Patient Identification
- A wallet card, an EMR hospital bracelet or the completed form can be used by EMS personnel.
- How do you obtain a DNR bracelet
- Once the DNR form is signed, you can obtain a bracelet.
- Revoking a DNR
- You may revoke the DNR at any time, either orally or in writing. You may also revoke the DNR by destroying the DNR form, wallet card or DNR bracelet.
- Photocopy
- A photocopy is recognized as an authentic DNR form.
- State info link:
- http://codes.ohio.gov/orc/2133.02
- Other links:
- 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 Ohio DNR form on file. Some bracelet sources include:
- 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.
Ohio has two types of DNR forms. In addition, your Living Will may include some DNR language. Discuss these options with your physician or attorney and select the one appropriate for your intentions.
Tagged as: DNR form, DNR Order, do not resuscitate (DNR), do not resusitate, Ohio do not resuscitate order
- Document Name
- “Nonhospial Order Not to Resuscitate”
- Where do you get the form
- Only a licensed physician can complete the form. and he or she. should have a copy of the DNR Order. If you need to provide a for to your physician, click here: http://tinyurl.com/djekqu
- Who signs the form
- The physician and the patient can consent to a DNR order orally or in writing, if two adult witnesses are present. When consent is given orally, one of he witnesses must be a physician affiliate with th hospital.
- Patient Identification
- New York EMS will honor the DNR Order form or a DNR bracelet issued by Medic Alert.
- How do you obtain a DNR bracelet
- Once the DNR form is signed, you can obtain a bracelet Medic Alert.
- Revoking a DNR
- You, or anyone who consents to a DNR 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 DNR revocation in your chart, cancel the DNR order and make diligent efforts to retrieve all copies of your DNR form, as well as your DNR bracelet.
- Photocopy
- A photocopy is recognized as an authentic DNR form.
- State info link
- http://tinyurl.com/cksdvz
http://tinyurl.com/dna9dm - Other link
- 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.
Tagged as: DNR form, DNR Order, do not resuscitate (DNR), do not resusitate, New York do not resuscitate form
- Document Name:
- UNIFORM DO-NOT-RESUSCITATE (DNR) ADVANCE DIRECTIVE
- Where do you get the form
- A physician must complete the form on your behalf. To obtain a copy of the IDPH Uniform DNR Advance Directive, you may request one from your health-care professional or facility. Copies also are available on the Illinois Department of Public Health’s Web site located at www.idph.state.il.us/public/books/advin.htm.
- Who signs the form
- The form is signed by the physician, the patient, and two witnesses and printed on brightly cooolored ORANGE paper.
- Patient Identification
- There is no requirement for a patient to wear a DNR identification bracelet. EMS will honor a DNR form signed by a physician, patient and 2 witnesses.
- How do you obtain a DNR bracelet
- If you want to wear a DNR bracelet, you can order one from one of the linke listed below.
- Revoking a DNR
- The DNR order can be revoked in a variety of ways, such as by writing “VOID” in large letters across the front of the form. If you revoke a DNR order, you also should tell your family members, as well as each health-care professional and provider that has received a copy of the order. You may then choose not to have a DNR order, or you may choose to complete a new DNR order reflecting any changes you wish .
- Photocopy
- Photocopies of a completed IDPH Uniform DNR Advance Directive are valid.
- State info link
- http://tinyurl.com/ltm527
- State statute link:
- http://tinyurl.com/ddgby4
- Other links
- http://www.vialoflife.com/
- DNR Bracelet links
- You can elect to purchase a DNR bracelet at these links.
- 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. The original DNRO order MUST be printed on ORANGE paper, 8 ½ by 11.
Tagged as: DNR form, DNR Order, do not resuscitate (DNR), do not resusitate, Illinois do not resuscitate order
