Blank Do Not Resuscitate Order Template for the State of New York

Guidelines on Utilizing New York Do Not Resuscitate Order

Filling out a New York Do Not Resuscitate (DNR) Order is a significant step for individuals wishing to make clear their preferences for end-of-life care. This document helps ensure that medical personnel understand not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. Completing this form may involve conversations with healthcare providers and loved ones to make an informed decision. Below are the steps necessary for accurately filling out the New York DNR Order form.

1. Begin by gathering the necessary personal information, including the full name, date of birth, and address of the person the DNR order is for.
2. Review the form with a healthcare provider to discuss the implications and ensure it reflects the person's wishes accurately.
3. Complete the "Patient Information" section with the details collected in step one.
4. If the person is able to consent, they should fill in the "Patient Consent" section, indicating their decision not to receive CPR, and then sign and date the form in the presence of a witness.
5. In cases where the person is not able to consent due to their medical condition, a healthcare proxy or legal guardian may need to fill in the "Surrogate Consent" section, providing their signature and relationship to the patient.
6. Ensure the attending physician completes the "Physician Section," which includes verifying the patient's decision, signing, and adding their professional details like license number and contact information.
7. Discuss with the healthcare provider where the DNR order should be kept. It generally needs to be easily accessible, so in the event of an emergency, medical personnel can see it quickly.
8. Finally, make copies of the completed DNR order. Provide one to the primary care physician, keep one for personal records, and consider giving one to a close family member or the designated healthcare proxy.

After the DNR Order form is completed and properly filed, it's crucial to communicate this decision with family members and any caregivers involved in the person's life. This ensures that in the moment of need, everyone is clear on the individual's wishes, preventing any unnecessary confusion or distress during critical moments.

1. What is a Do Not Resuscitate Order (DNR) in New York?

   A Do Not Resuscitate Order, commonly referred to as a DNR, is a medical order in New York. It instructs health care providers not to perform CPR (cardiopulmonary resuscitation) if a patient's breathing stops or if the patient's heart stops beating. It is used to respect the patient's wishes in the event they cannot communicate their desires due to a medical condition or emergency.

2. How can someone get a DNR order in New York?

   To obtain a DNR order in New York, a patient must discuss their wishes with a healthcare provider, such as a doctor or nurse practitioner. The healthcare provider must then fill out the official New York DNR form, which must be signed by both the healthcare provider and the patient, or the patient's health care agent or surrogate if the patient is unable to sign.

3. Who can consent to a DNR order on behalf of a patient?

   If a patient is unable to consent due to their medical condition, a surrogate decision-maker, such as a health care agent appointed by a Health Care Proxy, a family member, or a close friend, can consent to a DNR order on behalf of the patient. This surrogate must prioritize the patient's own wishes or, if unknown, their best interests.

4. Does a DNR order have to be renewed in New York?

   In New York, a DNR order does not have an explicit expiration date. However, it is prudent for the order to be reviewed periodically, especially if the patient's medical condition changes. The healthcare provider may recommend a renewal or revision of the DNR order based on these changes or at the request of the patient or their surrogate.

5. Can a DNR order be revoked?

   Yes, a DNR order can be revoked at any time by the patient if they are capable of making their own healthcare decisions. Alternatively, the patient's surrogate can revoke the order if the patient had previously designated them to make healthcare decisions on their behalf. Revocation can be achieved through a verbal or written statement to a healthcare provider.

6. Is a DNR order applicable outside of a hospital setting in New York?

   Yes, in New York, a DNR order is valid in both hospital settings and non-hospital settings, such as at home or in a nursing home. For effectiveness outside of a hospital, it's crucial to ensure the DNR order is properly documented and easily accessible to emergency medical personnel.

7. Are there consequences for healthcare providers who do not follow a DNR order?

   Healthcare providers are legally obligated to follow a valid DNR order. Failure to comply with a patient's DNR order can lead to legal consequences, including potential liability for battery or medical malpractice. It's important for healthcare providers to verify the validity of the DNR order and understand the patient's wishes.

8. How does a DNR order differ from a living will or healthcare proxy in New York?

   A DNR order specifically instructs healthcare providers not to perform CPR in the event of cardiac or respiratory arrest. A living will, on the other hand, is a broader document that outlines a patient's wishes regarding various types of medical treatments in case they become incapacitated. A healthcare proxy is a form that allows an individual to appoint someone else to make health care decisions on their behalf if they are unable to do so. While these documents all play crucial roles in end-of-life planning, they serve different purposes and are used in different circumstances.

1. Not including all necessary patient information: A completed form must have comprehensive patient information. This includes the patient's full name, date of birth, and other identifying details. Leaving out any of this information could render the form invalid.

2. Failure to obtain the required signatures: The validity of the DNR order hinges on the appropriate signatures. This typically includes the signature of the patient or the patient’s healthcare proxy and the attending physician. Missing signatures can lead to a lack of legal standing for the DNR order.

3. Using incorrect or outdated forms: New York periodically updates its DNR order forms to reflect current laws and regulations. Using an outdated form may lead to processing delays or the form being completely disregarded.

4. Not consulting with a healthcare provider: Before filling out a DNR form, it's essential to discuss it with a healthcare provider. These discussions ensure that the patient’s medical condition and preferences are accurately reflected and understood.

5. Illegible handwriting: If the form is filled out by hand, illegible writing can lead to misinterpretations of the patient’s wishes. To avoid this, it's recommended to print clearly or, if possible, fill the form out electronically.

6. Inaccurate or incomplete description of patient wishes: The DNR form includes sections where specific patient wishes regarding resuscitation are detailed. Vague or incomplete descriptions in these sections can lead to confusion or misapplication of the patient’s intended instructions.

7. Not making copies or informing relevant parties: After completing and signing the DNR order, it is critical to make several copies. These copies should be readily available and given to relevant parties, including family members, healthcare proxies, and primary care physicians, to ensure that the patient’s wishes are honored.

By avoiding these mistakes, individuals can help ensure their wishes are clearly communicated and respected during critical health care decisions.

When making healthcare decisions in New York, particularly those concerning end-of-life care, it's crucial to be prepared with the right set of documents to ensure your wishes are properly communicated to healthcare providers. The New York Do Not Resuscitate (DNR) Order form is a critical piece in this puzzle, but it's often accompanied by other forms and documents that provide a more complete picture of your healthcare preferences. Here's a look at seven other forms and documents that are commonly used alongside a DNR Order.

• Medical Orders for Life-Sustaining Treatment (MOLST): This form complements the DNR order by providing more comprehensive instructions regarding other life-sustaining treatments, such as intubation, mechanical ventilation, and artificial nutrition and hydration.
• Health Care Proxy: This legal document allows you to appoint someone you trust as your health care agent, who will make health care decisions on your behalf if you are unable to do so yourself.
• Living Will: Unlike a Health Care Proxy, which designates a decision-maker, a Living Will allows you to outline specific medical treatments you do or do not wish to receive if you're unable to make decisions for yourself.
• Power of Attorney: This document is similar to a Health Care Proxy but is broader, allowing the person you designate (your agent) to make decisions about your property and finances in addition to health care decisions.
• Emergency Medical Services (EMS) DNR Form: This form informs emergency medical personnel that you have a DNR order in place. It is particularly useful for situations outside of a hospital setting.
• Non-Hospital DNR Order: Specifically designed for use in non-hospital settings, this form is a companion to the traditional DNR for those receiving care at home or in a hospice.
• HIPAA Release Form: While not directly related to decisions about treatment, this form is essential for allowing your healthcare providers to share your medical information with the people you have designated.

Having these documents in order, together with your New York DNR Order, ensures that your healthcare wishes are known, respected, and can be legally upheld. Preparing these documents in advance can provide peace of mind to you and your loved ones, knowing that decisions about your health care will reflect your desires. It's advisable to consult with a legal advisor or healthcare professional when preparing these documents to ensure they accurately represent your wishes and are filled out correctly.

• A Living Will is similar to a Do Not Resuscitate (DNR) Order in that it allows individuals to express their wishes concerning medical treatment at the end of their life. However, a Living Will is broader, covering more types of decisions beyond resuscitation, such as the use of ventilators or feeding tubes.

• A Health Care Power of Attorney (HCPOA) also shares similarities with a DNR. It designates someone to make health care decisions on an individual's behalf if they are unable to do so. While a DNR specifically addresses the issue of resuscitation, HCPOA covers a wide range of medical decisions, potentially including those related to life-sustaining treatments.

• POLST (Physician Orders for Life-Sustaining Treatment) forms go hand-in-hand with DNR Orders in many cases. Both documents are designed to guide emergency medical personnel and other healthcare providers in critical situations. The POLST form is more comprehensive, indicating a patient's preferences for various life-sustaining treatments, not just resuscitation.

• A Medical Orders for Scope of Treatment (MOST) is quite similar to both a DNR and POLST. It is a doctor's order that outlines a patient's wishes regarding treatments that are to be provided or withheld. While a DNR specifically refuses resuscitation, a MOST can provide instructions on a variety of interventions, including intubation, mechanical ventilation, and more.

• Ensure that the patient's information is entered correctly, including their full name, date of birth, and any identification numbers used by the medical facility.

• Have a detailed conversation with the patient or the patient's healthcare proxy about the implications of a Do Not Resuscitate (DNR) order. All questions should be answered thoroughly.

• Do not skip obtaining the required signatures. A DNR form needs to be signed by the patient or the patient's legal healthcare proxy, as well as the attending physician to be valid.

• Keep the language clear and avoid using medical jargon that could confuse the patient or their family.

• Ensure that the form is dated when filled out. The date is crucial for establishing when the order became effective.

• Do not use pencil or any erasable writing tool. Fill out the form using a black or blue ink pen to ensure that the document is permanent and tamper-proof.

• Make certain copies of the DNR order are readily available. Copies should be given to the patient or proxy, included in the patient’s medical records, and kept in an easily accessible place at home if the patient is receiving care there.

• Do not allow anyone who is not legally authorized to make healthcare decisions for the patient to initiate or complete the DNR form.

• Always review the DNR order periodically with the patient or the patient's healthcare proxy to ensure it still reflects the patient's wishes, especially after any significant change in health status.

When discussing a New York Do Not Resuscitate (DNR) Order, various misconceptions often cloud the public's understanding. It's vital to clear up these misunderstandings for those considering a DNR for themselves or their loved ones. Below are ten common misconceptions about the New York DNR Order form:

• It applies to all medical treatments. This is false. A DNR Order only applies to cardiopulmonary resuscitation (CPR). It does not affect other medical treatments, such as pain medication, nutrition, or antibiotics, unless specified otherwise in advance directives.
• It's only for the elderly or terminally ill. While it's often associated with these groups, a DNR Order can be relevant for anyone regardless of age or health status who wishes not to have CPR in the event their heart or breathing stops.
• Having a DNR means receiving lower quality care. This misconception is entirely unfounded. A DNR Order simply informs medical staff of your wishes regarding CPR; it does not impact the quality of other treatments or care provided.
• Doctors decide if a DNR Order is appropriate. The decision to have a DNR Order lies with the individual or their healthcare proxy, not the doctors. Healthcare professionals can provide advice and information, but the final decision is personal.
• A DNR Order is irreversible. Not true. A DNR Order can be revoked or modified at any time by the individual if they are capable, or by their healthcare proxy or legal guardian if the individual is not.
• A DNR needs to be notarized to be valid. In New York, a DNR Order does not need to be notarized. It must be filled out correctly and signed by the required parties.
• The family can override a DNR Order. If a DNR is in place, it reflects the individual's wishes, and family members cannot override it unless they have legal authority to do so, and there is evidence that the person's wishes have changed.
• A DNR Order limits access to hospice care. This is incorrect. A DNR Order does not limit options for end-of-life care, including hospice. Hospice care focuses on comfort, not cure, and respects patients' wishes, including DNR Orders.
• You must have a DNR Order to avoid CPR in a hospital. While having a DNR Order clearly communicates your wishes, it's essential to discuss these preferences with healthcare providers and, if applicable, include them in an advance directive.
• A verbal DNR Order is enough. Verbal wishes about not wanting CPR can guide family members and healthcare proxies in decision-making, but a formal, written DNR Order is necessary for healthcare providers to follow these specific instructions.

Understanding these key points about New York's Do Not Resuscitate Order form can help individuals and families make informed decisions that are respected by healthcare professionals.

• A Do Not Resuscitate (DNR) Order in New York is a medical order to not perform CPR if a patient's breathing stops or if the patient’s heart stops beating.

• The decision to sign a DNR should be made by the patient or the patient’s health care agent or surrogate, based on the patient’s wishes, religious beliefs, or ethical principles.

• This form must be filled out in consultation with a physician or a nurse practitioner who can help explain the implications and the scope of the DNR.

• A DNR Order is part of a larger approach to end-of-life care and does not impact other treatments. Patients can still receive medication and other forms of care aimed at comfort.

• It’s essential to communicate the existence of the DNR Order to all healthcare providers involved in the patient's care, including hospital staff and emergency personnel.

• The form must be kept in an easily accessible location and brought during hospital visits or any transfer between care settings.

• DNR Orders are legally binding across New York State and must be respected by healthcare professionals.

• Review and update the DNR Order regularly, especially if the patient's health condition changes or if the patient wishes to change their decision regarding resuscitation.