Homepage >> Fillable Do Not Resuscitate Order Template >> Free Do Not Resuscitate Order Form for the State of New York

Common mistakes

  1. Incomplete Information: Failing to fill out all required fields can lead to the form being invalid. Ensure that all sections are completed fully.

  2. Incorrect Signatures: The form must be signed by the patient or their legal representative. Missing or incorrect signatures can invalidate the order.

  3. Not Using the Correct Form: Using an outdated version or a form from another state can cause issues. Always use the latest New York Do Not Resuscitate Order form.

  4. Failure to Date the Form: Not including the date on which the form was signed can lead to confusion about its validity.

  5. Ignoring Witness Requirements: Some forms may require a witness signature. Not adhering to this requirement can render the document ineffective.

  6. Not Discussing with Healthcare Providers: Failing to communicate the decision to healthcare providers can lead to misunderstandings during emergencies.

  7. Inadequate Storage: Keeping the form in an inaccessible place may delay its use. Ensure that copies are stored where they can be easily found.

  8. Neglecting to Inform Family Members: Not informing family members about the order can create confusion and conflict during critical moments.

  9. Not Reviewing the Form Periodically: Life circumstances change. Regularly reviewing and updating the form is essential to ensure it reflects current wishes.

  10. Assuming Verbal Orders are Sufficient: Relying on verbal agreements instead of having a written form can lead to significant misunderstandings.

Similar forms

A Do Not Resuscitate (DNR) Order is a crucial document that outlines a person's wishes regarding medical intervention in the event of cardiac or respiratory arrest. While the DNR is unique in its focus on resuscitation, several other documents serve similar purposes in healthcare settings. Here are six documents that share similarities with the DNR Order:

  • Advance Directive: This document provides guidance on a person's healthcare preferences when they can no longer communicate their wishes. Like a DNR, it helps ensure that medical decisions align with an individual's values and desires.
  • Homeschool Letter of Intent: This form serves as a formal declaration of intent to homeschool in Arizona, essential for compliance with state regulations. For more information, visit https://azformsonline.com/homeschool-letter-of-intent/.
  • Living Will: A living will specifically addresses end-of-life care and outlines the types of medical treatments a person does or does not want. It serves a similar function to a DNR by clarifying preferences for care.
  • Healthcare Proxy: This document appoints someone to make medical decisions on behalf of an individual if they become incapacitated. It complements a DNR by ensuring that someone understands and advocates for the person's wishes.
  • POLST (Physician Orders for Life-Sustaining Treatment): This form translates a patient’s preferences into actionable medical orders. Like a DNR, it is designed for those with serious illnesses and provides clear instructions for emergency personnel.
  • Do Not Intubate (DNI) Order: This order specifically instructs healthcare providers not to insert a breathing tube if a patient cannot breathe independently. It is often used in conjunction with a DNR to clarify wishes regarding respiratory support.
  • Comfort Care Order: This document emphasizes palliative care and prioritizes the comfort of the patient over aggressive treatment. Similar to a DNR, it reflects a desire for a peaceful end-of-life experience without unnecessary interventions.

Dos and Don'ts

When considering the New York Do Not Resuscitate (DNR) Order form, it’s essential to approach the process with care and clarity. This document can have profound implications for your medical care and decisions at the end of life. Below are some important do's and don'ts to keep in mind while filling out the form.

  • Do ensure that the form is filled out completely and accurately.
  • Do discuss your wishes with your healthcare provider and family members.
  • Do keep a copy of the signed DNR order in an easily accessible place.
  • Do review the form periodically to ensure it still reflects your wishes.
  • Don't sign the form without fully understanding its implications.
  • Don't assume that verbal instructions are enough; a written order is required.
  • Don't forget to inform all relevant medical personnel about your DNR status.
  • Don't neglect to update the form if your health status or preferences change.

Preview - New York Do Not Resuscitate Order Form

New York Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is established in accordance with New York State laws regarding advance directives and end-of-life care.

Patient Information:

  • Patient's Name: ___________________________
  • Date of Birth: ___________________________
  • Address: ___________________________
  • Phone Number: ___________________________

Authorized Person's Information:

  • Health Care Agent's Name: ___________________________
  • Relationship to Patient: ___________________________
  • Contact Number: ___________________________

Effective Date: ___________________________

By signing this document, I hereby declare that in the event my heart stops beating or I stop breathing, I do not wish for resuscitation efforts to be performed on my behalf.

Signature of Patient: ___________________________

Date: ___________________________

If the patient is unable to sign, the Health Care Agent may sign on their behalf:

Signature of Health Care Agent: ___________________________

Date: ___________________________

Witness Signature: ___________________________

Date: ___________________________

Misconceptions

Understanding the New York Do Not Resuscitate (DNR) Order form is crucial for making informed healthcare decisions. However, several misconceptions surround it. Here are ten common misunderstandings:

  1. A DNR means I am giving up on treatment. Many people think that signing a DNR means they are refusing all medical care. In reality, it only indicates that you do not want to be resuscitated if your heart stops or you stop breathing.
  2. Only terminally ill patients need a DNR. A DNR can be appropriate for anyone who wishes to avoid resuscitation, not just those with terminal illnesses. It’s about personal choice.
  3. Signing a DNR means I will not receive any medical care. This is false. You will still receive all other necessary medical treatments and care, just not resuscitation efforts.
  4. A DNR is only valid in hospitals. A DNR can be valid in various settings, including at home or in nursing facilities, as long as it is properly documented and recognized by healthcare providers.
  5. Once I sign a DNR, I can’t change my mind. You can change or revoke a DNR at any time. Your wishes can evolve, and your healthcare documents should reflect that.
  6. A DNR is the same as a living will. While both documents relate to healthcare decisions, a DNR specifically addresses resuscitation efforts, whereas a living will covers broader medical treatment preferences.
  7. Healthcare providers will not respect my DNR. Healthcare providers are legally obligated to honor valid DNR orders. It is important to ensure that your DNR is properly completed and accessible.
  8. I need a lawyer to create a DNR. You do not need a lawyer to fill out a DNR form. However, it can be helpful to discuss your wishes with a healthcare professional.
  9. My family can override my DNR wishes. A valid DNR order reflects your wishes. Family members cannot override it unless they have legal authority, such as a healthcare proxy.
  10. All DNR forms are the same. DNR forms can vary by state. It’s essential to use the correct form for New York and ensure it meets all legal requirements.

Being informed about these misconceptions can help individuals make better decisions regarding their end-of-life care. Understanding the DNR process is a vital step in advocating for your own healthcare preferences.

How to Use New York Do Not Resuscitate Order

Filling out the New York Do Not Resuscitate Order form is an important step in making your healthcare wishes known. After completing the form, you will need to ensure that it is signed and witnessed properly. This will help ensure that your preferences are respected in a medical setting.

  1. Obtain the New York Do Not Resuscitate Order form. You can find this form online or request it from your healthcare provider.
  2. Fill in your personal information, including your full name, address, and date of birth. Make sure this information is accurate.
  3. Indicate your wishes regarding resuscitation by checking the appropriate box. Be clear about your decision.
  4. Sign and date the form at the designated area. Your signature confirms your wishes.
  5. Have the form witnessed. You will need one witness who is not a family member or someone who will benefit from your estate.
  6. Provide a copy of the completed form to your healthcare provider and keep a copy for your records.

Once you've filled out the form, make sure to discuss your decision with your family and healthcare team. This conversation can help everyone understand your wishes and ensure they are honored when the time comes.