- Document Name
“Out of Hospital DNR Order”
- 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://www.njha.com/ps/pdf/dnr.pdf The form can be found on pages 13-14.
- Who signs the form
The physician and the patient.
- 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.
A photocopy is recognized as an authentic DNR form.
- State info link
- Other links
- DNR Bracelet links
- Once you complete the DNR form, you can order a DNR bracelet. There is no requirement for information from the form to be available on the bracelet.
- 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.