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.
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.
“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. 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.
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. Here’s one bracelet source you can check:
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 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.
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.
National, state and local organizations have joined together to ensure that all adults have the opportunity to communicate and document their healthcare decisions. Too often, someone’s wishes are not known and steps are taken during a critical medical situation that he or she would not have wanted.
Have you done any advance healthcare planning? Do you even know what your choices are? Have you prepared an advance healthcare directive and shared its contents with your loved ones?
The objectives of the National Healthcare Decisions Day are to provide information to the public and improve the ability of healthcare facilities and providers to offer guidance about advance healthcare planning to their patients.
Don’t force your family to make end of life decisions for you. Tell them what you want and confirm your choices in writing with a living will or other advance directive document. Make April 16th the day you have a discussion with your family, convey your wishes and sign the necessary paperwork.
In an effort to help DieSmart visitors become more educated about the significance of the proposed health care reform legislation, DieSmart will aggregate and post articles from a variety of sources for your review.
