Tag Archives: DNR bracelet

Do Not Resuscitate (DNR) & POLST California

Document Name: Emergency Medical Services Pre-Hospital Do Not Resuscitate (DNR) form; Physician Orders for Life Sustaining Treatment (POLST) form
Where do you get the forms: You should get the DNR or POLST form from a medical professional or download it here: http://www.emsa.ca.gov/Forms
Who is permitted to request a DNR or a POLST

A patient with a life threatening illness or injury can request a DNR or a POLST.

Who signs the form: The form is signed by the physician as well as the patient.
Patient Identification: There is no requirement for a patient to wear a DNR identification medallion. However, California does recognize the medallion as proof of the patient having a DNR order.
How do you obtain a DNR medallion: There are currently only two state approved providers who can produce the pre-hospital DNR medallions. They are:; Medic Alert Foundation 888-633-4298 http://www.medicalert.org; Caring Advocates 800-647-3223 http://www.caringadvocates.org; You will have to submit a copy of the DNR prior to being allowed to purchase a medallion.
Revoking a DNR or a POLST: An order can be revoked at any time. Just destroy the paperwork and also notify your doctor’s office and family.
Photocopy: Photocopies of a completed DNR or POLST form are valid.
State info link

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.

Document Name: MOLST (Medical orders for life sustaining treatments) has taken the place of the Comfort Care/Do Not Resuscitate Verification. However, existing DNRs will be honored.
Where do you get the form: You can find it on the mass.gov site or you can get it from your physician.
Who signs the form: The form is signed by the physician, a nurse practitioner or a physician’s assistant and the patient.

Any adult can complete a MOLST form.

Patient Identification: The Comfort Care/DNR verification is the only document that EMS personnel can use to verify a DNR order is valid. If a person has a MOLST, the form itself can be used.
How do you obtain a DNR or MOLST bracelet: Your physician must order a DNR bracelet for you. The MOLST application contains bracelet inserts that can be used in generic wrist bracelets.
Revoking a DNR or MOLST: An EMS/DNR Order or MOLST may be revoked at any time.
Photocopy: Photocopies of the form or the bracelet inserts are considered authentic DNR or MOLST documents. Because EMTs are trained to look for a bright pink form in outpatient settings, it is highly recommended that a bright pink-colored DNR or MOLST form stays with the patient at all times.
State info link: http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/oems/comfort-care/; http://www.molst-ma.org/
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 or MOLST has been prepared and can be found in your refrigerator.

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.

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.