Tag Archives: do not resusitate

Do Not Resuscitate (DNR) Michigan

Document Name
Do Not Resuscitate Order
Where do you get the form
Physicians should have copies of the form.  You can also get a copy at most hospices or download one here:
http://michigan.gov/documents/mdch/Do_not_resuscitate.policy_298357_7.pdf
Who signs the form
A physician must sign the DNR.   However, people whose religion opposes medical treatment don’t need a doctor’s signature.

Who can request the form

It may be requested by any individual 18 years or over.

Patient Identification
EMS will act based uon the information contained in the DNR.
How do you obtain a DNR bracelet
Once you have your DNR form completed, you can call the Michigan Hospice and Palliative Care Organization at 800-536-6300 to request a bracelet.
Revoking a DNR
You can revoke a DNR by tearing up the DNR form and returning any DNR identification bracelets.
Photocopy
A photocopy is considered an authentic document
State info link
http://michigan.gov/mdch/0,4612,7-132-2940_3183_4895-19875–,00.html
Other link
http://www.vialoflife.com
DNR Bracelet links
You must call the Michigan Hospice and Palliative Care Organization at 800-536-6300. 
Special Notes

Do Not Resuscitate (DNR) Georgia

Document Name
Do Not Resuscitate Order
Where do you get the form
Ask your physician to create a DNR on your behalf.  If your physician does not have a form, there is a sample as part of the Georgia statute.  Go to
http://www.lexisnexis.com/hottopics/gacode/Default.asp 

and then look for Title 31. Health Chapter 39. O.C.G.A. 31-39-4

Who signs the form
The physician will sign the form.

Who can request a DNR

Any patient who has a medical condition which can be expected to result in imminent death or for whom CPR would be medically futile because it might only restore cardiac and respiratory function for a brief period of time.  A legal representative can also request a DNR for a patient who is in a vegetative or other unconscious state.

Patient Identification
There is no requirement for a patient to wear a DNR identification bracelet but it is acceptalbe if the patient chooses to do so.  However, there are specific guidelines.  The bracelet must be similar to identification bracelets worn in hospitals and must provide the following information in boldface type: DO NOT RESUSCITATE ORDER.  Patient’s name: _____________; authorized person’s name and phone number, if applicable; patient’s physician’s printed name and phone number; date of order not to resuscitate.                                    
How do you obtain a DNR bracelet
For assistance with finding a vendor for bracelets or necklaces, contact the Office of Regulatory Services at (404) 657-4076.
Revoking a DNR
You, or your designated health care agent, can give different instructions at any time, either orally, or by notifying your physician in writing.
Photocopy
You can make a photocopy of the original DNR form.
State info link
http://aging.dhr.georgia.gov/sites/aging.dhs.georgia.gov/files/imported/DHR-DAS/DHR-DAS_Publications/ELAP-%20DNR-12.pdf
Other link
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.

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.