Tag Archives: do not resuscitate (DNR)

Do Not Resuscitate (DNR) Massachusetts – has transitioned to MOLST

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.

Who can request the form

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.

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) 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) New York (& 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. 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
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. Here’s one bracelet source you can check:

Medic Alert Foundation International, Attn DNR, 2323 Colorado Avenue, Turlock, CA 95382 Phone: 1-888-633-4298, 3, 1 or ask for DNR. http://www.medicalert.org/product/catalog/medical-ids

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.