Free Do Not Resuscitate Order Form for New York State

1. Inaccurate Personal Information: Individuals sometimes fail to provide complete and accurate personal details. This can include missing names, addresses, or dates of birth. Such omissions can lead to confusion and delays in honoring the order.

2. Signature Issues: Some people neglect to sign the form or provide a signature that does not match the name written. A missing or inconsistent signature may render the document invalid.

3. Failure to Include Witness Signatures: The form typically requires signatures from witnesses. Omitting this step can result in the order not being recognized by healthcare providers.

4. Not Discussing the Order with Healthcare Providers: Individuals often fill out the form without discussing their wishes with doctors or family members. This can lead to misunderstandings about the intent behind the order.

5. Using an Outdated Version of the Form: Some may mistakenly use an old version of the Do Not Resuscitate Order form. It's essential to ensure that the most current version is being used to avoid any legal complications.

When considering a New York Do Not Resuscitate Order (DNR), it’s essential to understand that this document is often accompanied by other important forms. These documents work together to ensure that your healthcare preferences are respected and clearly communicated. Below is a list of forms that are commonly used alongside the DNR.

• Health Care Proxy: This document allows you to appoint someone to make medical decisions on your behalf if you become unable to do so. It’s crucial for ensuring that your wishes are followed in situations where you cannot communicate.
• Living Will: A living will outlines your preferences regarding medical treatment in situations where you are terminally ill or incapacitated. This document helps guide your healthcare providers and loved ones in making decisions that align with your values.
• Physician Orders for Life-Sustaining Treatment (POLST): This form translates your wishes regarding life-sustaining treatments into actionable medical orders. It is especially useful for individuals with serious illnesses who want to ensure their preferences are honored across various care settings.
• Advance Directive: An advance directive encompasses both the health care proxy and living will. It serves as a comprehensive guide to your healthcare preferences and appoints someone to advocate for your wishes.
• Do Not Hospitalize Order: This document expresses your desire to avoid hospitalization in certain situations, particularly for individuals with terminal illnesses. It helps healthcare providers understand your preferences for end-of-life care.
• Organ Donation Form: If you wish to donate your organs upon death, this form allows you to express your intent. It can be included with other advance care planning documents to ensure your wishes are clear.
• Emergency Medical Information Form: This form provides crucial health information to emergency responders. It includes details about your medical history, allergies, and any relevant medications, ensuring that first responders have the information they need in critical situations.
• Patient Identification Card: A patient ID card can be used to quickly communicate your DNR status and other medical preferences. It can be carried in your wallet or purse for easy access by healthcare professionals in emergencies.

Understanding these forms and how they complement the New York Do Not Resuscitate Order can empower you to make informed decisions about your healthcare. Each document plays a vital role in ensuring that your wishes are honored and that you receive the care you desire.

When filling out and using the New York Do Not Resuscitate Order form, it is important to keep several key points in mind. These takeaways will help ensure that the process is understood and executed properly.

• The form must be completed by a licensed physician. Only a doctor can authorize a Do Not Resuscitate (DNR) order.
• Once the form is signed, it should be prominently displayed in the patient’s medical records and at their residence, ensuring that emergency personnel can easily access it.
• Patients or their legal representatives must fully understand the implications of a DNR order, as it means that no attempts will be made to revive the patient in the event of cardiac or respiratory arrest.
• It is essential to review and update the DNR order regularly, especially if the patient’s health status changes or if they wish to revoke the order.

The Advance Directive is a legal document that outlines a person's wishes regarding medical treatment in case they become unable to communicate those wishes. Like the Do Not Resuscitate Order, it allows individuals to express their preferences about life-sustaining measures. Both documents serve to guide healthcare providers and loved ones in making decisions that align with the patient's values and desires.

A Living Will is another important document that shares similarities with the Do Not Resuscitate Order. It specifically details the types of medical treatment a person wants or does not want at the end of life. While the DNR focuses on resuscitation efforts, a Living Will covers a broader range of medical interventions, ensuring that a person's healthcare choices are respected in critical situations.

The Healthcare Proxy allows individuals to appoint someone to make medical decisions on their behalf if they become incapacitated. This document complements the Do Not Resuscitate Order by ensuring that the appointed person understands and can advocate for the patient’s wishes regarding resuscitation and other medical treatments.

Physician Orders for Life-Sustaining Treatment (POLST) is similar to the DNR in that it provides specific medical orders for patients with serious illnesses. It goes beyond a DNR by addressing various treatment options, allowing patients to detail their preferences for life-sustaining measures. Both documents aim to ensure that healthcare providers honor the patient's wishes.

The Medical Power of Attorney is a legal document that designates someone to make healthcare decisions for another person. Like the Do Not Resuscitate Order, it empowers individuals to have control over their medical care. This document can work alongside a DNR to ensure that the designated agent understands and can implement the patient's wishes regarding resuscitation.

The Do Not Intubate Order is closely related to the DNR, as it specifically states that a patient does not want to be placed on a ventilator. Both documents reflect a person's wishes to avoid aggressive life-saving measures. They serve as clear instructions to medical professionals about the patient's preferences in critical situations.

The Comfort Care Order focuses on providing relief from pain and distress rather than aggressive treatment. It aligns with the principles of the Do Not Resuscitate Order by prioritizing comfort over life-sustaining measures. Both documents emphasize the importance of quality of life and allow individuals to choose a peaceful end-of-life experience.

A Do Not Hospitalize Order is a directive that expresses a person's wish to avoid hospitalization during a medical crisis. Similar to the DNR, it reflects a desire to remain in a familiar environment and receive care that aligns with their values. Both documents help ensure that medical decisions are made in accordance with the patient's preferences.

The End-of-Life Care Plan outlines a person's wishes for care during their final days. It can include preferences about resuscitation and other medical interventions, similar to the Do Not Resuscitate Order. This plan helps families and healthcare providers understand the individual’s desires, ensuring that their end-of-life experience is respectful and aligned with their values.

Finally, the Hospice Care Plan is a document that details the care and support a person wishes to receive during their final stages of life. Like the Do Not Resuscitate Order, it focuses on comfort and quality of life rather than curative treatment. Both documents are essential for guiding healthcare providers in delivering compassionate care that honors the patient’s wishes.

When filling out the New York Do Not Resuscitate Order form, it’s essential to approach the process with care. Here are some important dos and don'ts to keep in mind:

• Do ensure that you fully understand what a Do Not Resuscitate Order means.
• Do discuss your wishes with your healthcare provider and family members.
• Do fill out the form clearly and legibly to avoid any misunderstandings.
• Do keep a copy of the completed form in a safe place and share it with relevant parties.

• Don't rush through the process; take your time to consider your decisions.
• Don't leave any sections of the form blank unless specified.
• Don't forget to sign and date the form where required.
• Don't assume that verbal instructions are enough; always use the official form.