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The New York Do Not Resuscitate Order form is a critical document for individuals who wish to express their preferences regarding medical treatment in emergency situations. This form allows patients to indicate that they do not want resuscitation efforts, such as CPR, if their heart stops or they stop breathing. It is essential for ensuring that a person's wishes are respected during medical emergencies. The form must be completed and signed by a licensed physician, and it requires the patient’s or their legal representative's consent. It is important to understand that the DNR order applies only in specific circumstances and does not affect other medical treatments. Additionally, it should be readily available to medical personnel, as it guides their actions in urgent situations. Understanding the implications and proper use of this form is vital for anyone considering it, as it directly impacts end-of-life care and the quality of life during critical moments.
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Common Questions
What is a Do Not Resuscitate (DNR) Order in New York?
A Do Not Resuscitate Order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a person's heart stops beating or they stop breathing. In New York, this order is designed to respect the wishes of individuals who do not wish to receive life-saving measures in certain medical situations.
Who can request a DNR Order?
In New York, a DNR Order can be requested by an adult patient who is capable of making their own medical decisions. If the patient is unable to make decisions, a legally appointed representative, such as a healthcare proxy or family member, may request the order on their behalf.
How do I obtain a DNR Order form?
You can obtain a DNR Order form from various sources, including hospitals, healthcare providers, and online resources provided by the New York State Department of Health. It is important to ensure that you are using the most current version of the form.
What information is required on the DNR Order form?
The DNR Order form requires specific information, including the patient's name, date of birth, and the signature of the patient or their representative. Additionally, the form must be signed by a physician to be valid. This physician must confirm that the patient has the capacity to make informed decisions about their medical care.
Is a DNR Order valid in all healthcare settings?
Yes, a properly completed and signed DNR Order is valid across various healthcare settings in New York, including hospitals, nursing homes, and home care situations. However, it is essential to communicate your wishes clearly to all healthcare providers involved in your care.
Can I change or revoke a DNR Order?
Yes, you can change or revoke a DNR Order at any time. To do so, you should inform your healthcare provider and complete a new DNR Order form if necessary. It’s important to ensure that all relevant parties are aware of any changes to your wishes.
What happens if I do not have a DNR Order?
If you do not have a DNR Order in place and your heart stops or you stop breathing, medical personnel will typically perform CPR and other life-saving measures. This may not align with your wishes if you prefer not to receive such interventions.
How does a DNR Order affect other medical treatments?
A DNR Order specifically addresses resuscitation efforts and does not affect other medical treatments. You can still receive all other types of medical care, including medications, pain relief, and comfort measures, even if you have a DNR Order in place.
Is a DNR Order the same as a Living Will?
No, a DNR Order and a Living Will are different documents. A Living Will outlines your preferences for medical treatment in situations where you cannot communicate your wishes, while a DNR Order specifically addresses your wishes regarding resuscitation efforts. Both documents can work together to ensure your healthcare preferences are honored.
Where should I keep my DNR Order?
It is crucial to keep your DNR Order in a place where it can be easily accessed by healthcare providers. Consider keeping a copy with your medical records, at home, or in a visible location, such as on your refrigerator. Inform your family and healthcare proxy about its location to ensure they can provide it when needed.
Preview - New York Do Not Resuscitate Order Form
New York Do Not Resuscitate Order Template
This Do Not Resuscitate (DNR) Order is made in accordance with New York State Law (Public Health Law § 2994-d). This document allows individuals to express their wishes regarding resuscitation in the event of a medical emergency.
Patient Information:
- Name: _______________________
- Date of Birth: ________________
- City: _________________________
- State: ________________________
- Zip Code: _____________________
Health Care Proxy Information (if applicable):
- Name: _______________________
- Phone Number: ________________
- Address: ________________________)
Do Not Resuscitate Order:
I, the undersigned, hereby request the medical team to withhold resuscitation in the event that my heart stops beating or I stop breathing.
This order applies to the following situations:
- Cardiac arrest.
- Respiratory arrest.
Signatures:
Patient Signature: ___________________________
Date: ______________________________________
Health Care Proxy Signature (if applicable): _____________________
Date: ______________________________________
Witness Signatures:
- Witness Signature: ______________________ Date: _______________
- Witness Signature: ______________________ Date: _______________
This document should be kept in a place where it can be easily accessed by medical personnel.
For further information about DNR orders and health care proxies in New York, consult a healthcare professional or legal advisor.
Similar forms
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Advance Healthcare Directive: This document allows individuals to outline their healthcare preferences in advance, including decisions about life-sustaining treatments. Like a Do Not Resuscitate Order, it communicates a person’s wishes regarding medical care when they are unable to speak for themselves.
-
Living Will: A living will specifies the types of medical treatments a person does or does not want in the event they become incapacitated. It serves a similar purpose to a Do Not Resuscitate Order by providing guidance to healthcare providers about the individual’s treatment preferences.
- Residential Lease Agreement: The Ohio PDF Forms provides a structured format for landlords and tenants to agree on rental terms, ensuring clarity and protection for both parties involved in residential agreements.
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Durable Power of Attorney for Healthcare: This document designates a trusted person to make healthcare decisions on behalf of an individual if they are unable to do so. It complements a Do Not Resuscitate Order by ensuring that someone can advocate for the individual's wishes regarding resuscitation and other medical interventions.
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Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that outlines a patient’s preferences for emergency medical treatment. Similar to a Do Not Resuscitate Order, it provides clear instructions to healthcare providers about the individual’s wishes in critical situations.
Misconceptions
- Misconception 1: A Do Not Resuscitate (DNR) order means that no medical care will be provided.
- Misconception 2: DNR orders are only for terminally ill patients.
- Misconception 3: A DNR order is permanent and cannot be changed.
- Misconception 4: All healthcare providers must follow a DNR order.
- Misconception 5: A DNR order only applies in hospitals.
- Misconception 6: DNR orders are the same as living wills.
- Misconception 7: You need a lawyer to create a DNR order.
- Misconception 8: A DNR order will lead to neglect of the patient.
- Misconception 9: DNR orders are only for older adults.
- Misconception 10: DNR orders are difficult to obtain.
This is not true. A DNR order specifically addresses resuscitation efforts in the event of cardiac arrest. Other medical treatments and care can still be provided.
DNR orders can be requested by anyone who wishes to avoid resuscitation, regardless of their overall health status. It is a personal choice.
This is false. A DNR order can be revoked or modified at any time by the patient or their legal representative.
While most providers will honor a DNR order, there may be exceptions in certain situations, such as in a hospital setting where specific protocols are in place.
A DNR order is valid in various settings, including at home, nursing homes, and other healthcare facilities, as long as it is properly documented.
While both documents address end-of-life care, a DNR specifically pertains to resuscitation efforts, whereas a living will outlines broader healthcare preferences.
This is not necessary. Individuals can complete a DNR order form without legal assistance, though consulting a lawyer may be helpful for understanding options.
Healthcare providers are trained to provide appropriate care and comfort measures, even when a DNR order is in place.
People of all ages can have DNR orders. It is a personal decision that can be made based on individual health circumstances and preferences.
Obtaining a DNR order is usually straightforward. Individuals can fill out the necessary forms and discuss their wishes with their healthcare providers.
Form Overview
| Fact Name | Description |
|---|---|
| Definition | A Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform CPR if a patient's heart stops or they stop breathing. |
| Governing Law | The DNR Order in New York is governed by Public Health Law § 2967. |
| Eligibility | Any adult patient, or a legally authorized representative, can request a DNR Order. |
| Form Requirement | The New York State DNR form must be completed and signed by a physician. |
| Revocation | A DNR Order can be revoked at any time by the patient or their representative. |
| Emergency Services | Emergency medical services (EMS) personnel must honor a valid DNR Order. |
| Location | The DNR Order should be kept in a visible location, such as on the refrigerator or in a medical file. |
| Patient Autonomy | A DNR Order reflects the patient's wishes regarding end-of-life care and promotes patient autonomy. |
| Healthcare Proxy | A healthcare proxy can also make decisions about a DNR Order if the patient is unable to do so. |
| Additional Documentation | In some cases, a DNR Order may be accompanied by an advance directive or living will. |