Tag Archives: do not resuscitate (DNR)

Do Not Resuscitate (DNR) Ohio

Document Name:
Ohio has two versions of the DNR – “Do Not Resuscitate Comfort Care Order ” AND ” Do Not Resuscitate Comfort Care Order-Arrest Order”.  The difference relates to the amount and timing of care given.  Ask your medical professional for an explanation.

Where do you get the form

A physician, a certified nurse practitioner or a clinical nurse specialist can provide the form or you can get it here: http://www.odh.ohio.gov/pdf/forms/dnrfrm.pdf
Who signs the form
The physician, certified nurse practitioner or clinical nurse specialist and the patient sign the DNR order.

Who can request a DNR

Any adult can request one.

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
The state of Ohio does not endorse a specific vendor but supplies a list of suggestions on their site:
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
http://codes.ohio.gov/orc/2133.21
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. Here is a link to the list on the Ohio state website: http://www.odh.ohio.gov/~/media/ODH/ASSETS/Files/dspc/health%20care%20service/jewerlyresourcelist6/08.ashx
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.

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.

Do Not Resuscitate (DNR) New Jersey

Document Name
“Out of Hospital DNR Order”
Where do you get the form
You can get a copy of the DNR Order from a licensed physician. If you need to provide a form  to your physician, click here: http://www.state.nj.us/health/ems/dnr_introduction.shtml
Who signs the form
The physician and the patient or patient surrogate.

Who can request the form

Any mentally competent adult patient can request it.

Patient Identification
New Jersey EMS will honor the DNR Order form or a DNR bracelet that is worn on the patient’s ankle or wrist, has an insert displaying the patient’s name, physician name and date of the DNR, and has never been cut or removed.
How do you obtain a DNR bracelet
Once the DNR form is signed, you can obtain a bracelet from your physician or any health care facility licensed by the state of New Jersey (hospitals, long term care facilities, nursing homes, hospice). Call 1-973-857-5552 for more information.
Revoking a DNR
A DNR order may be revoked by the patient by removing the bracelet, verbally requesting the DNR be revoked, or destroying the DNR form. The patient should report the revocation of the DNR to their physician.
Photocopy
A photocopy is recognized as an authentic DNR form.
State info link
http://www.state.nj.us/health/ems/dnr_introduction.shtml
Other links
http://www.vialoflife.com/
DNR Bracelet links
Once you complete the DNR form, you can order a DNR bracelet from any vendor.  However, you will have to show proof that you have a valid DNR.
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.

Do Not Resuscitate (DNR) Illinois

Document Name:
Illinois Department of Public Health (IDPH) Uniform Do-Not_Resuscitate (DNR) Advance Directive
Where do you get the form
To obtain a copy of the IDPH Uniform DNR form, 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 http://www.idph.state.il.us/public/books/advin.htm or by calling 217-785-2080
Who signs the form
The form is signed by the physician, the patient, and one witness.
Who can request a DNR

An adult or an emancipated minor who does not wish to have CPR attempted when his or her heart and/or breathing stops may have a DNR order.

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 one witness.
How do you obtain a DNR bracelet
The IDPH does not specify any specific company from which to purchase the bracelet.  You should ask your physician for a recommendation when meeting to discuss the DNR form.
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 are valid.
State info link
http://www.idph.state.il.us/public/books/advdir4.htm
State statute link:
http://www.ilga.gov/legislation/ilcs/documents/075500400K65.htm
Other links
http://www.vialoflife.com/
DNR Bracelet links
Illinois does not recommend a specific vendor.  However, two you might try are:
Appomattox Drug Store http://tinyurl.com/cf5jdg
Medic Alert Foundation International http://tinyurl.com/dk3yun
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.

Do Not Resuscitate (DNR) Alaska

Document Name
Emergency Medical Services Prehospital Do Not Resuscitate Order
Where do you get the form
You can  request a copy from the State Emergency Medical Services Department.
Who signs the form
The form is signed by the physician and the patient.
Patient Identification
The form is a three-part form. Give a copy of the form to EMS personnel.
How do you obtain a DNR bracelet
If you decide to wear a DNR bracelet, ask your physician to order a Comfort One DNR bracelet for you. The cost is $20.
Revoking a DNR
If you change your mind, destroy the enrollment forms, the wallet card and, if appropriate, the DNR bracelet. Also, notify your physician in writing that you have changed your mind.  If you are unable to communicate yourself, a person with a durable power of attorney can revoke the DNR status.
State links
http://www.chems.alaska.gov/ems/Comfort_One.htm
Other links
http://www.vialoflife.com/
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.