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Blank Do Not Resuscitate Order Template for New Jersey

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In New Jersey, the Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals who wish to make their end-of-life care preferences known, particularly regarding resuscitation efforts in the event of cardiac or respiratory arrest. This form is designed to communicate a person's desire to forgo CPR and other life-saving measures, ensuring that healthcare providers respect these wishes in critical situations. It is important to understand that the DNR Order is not a declaration of the individual’s overall health care preferences but specifically addresses the desire to avoid resuscitation. The form must be signed by a physician and can be completed by patients or their authorized representatives, allowing for personal choice in medical care. Additionally, it is essential for individuals to discuss their wishes with family members and healthcare providers to ensure everyone is informed and in agreement. The DNR Order must be readily accessible, as it should be presented in emergencies where immediate medical decisions are necessary. Understanding the implications of this document can empower individuals to make informed choices about their healthcare and ensure that their wishes are honored when it matters most.

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Discover Other Common Do Not Resuscitate Order Forms for Specific States

Michigan Do Not Resuscitate Form - Surrogates or healthcare proxies may be involved in discussions about a patient’s DNR preferences.

Polst Form Georgia - A DNR order must be documented in the patient’s medical record to be valid.

Out of Hospital Dnr - You can place a DNR order in your medical records for easy access by professionals.

Illinois Do Not Resuscitate Law - The decision to sign a DNR should be a personal one.

Steps to Using New Jersey Do Not Resuscitate Order

Filling out the New Jersey Do Not Resuscitate Order form is an important step for individuals who wish to communicate their preferences regarding resuscitation in a medical emergency. Completing this form ensures that your wishes are known and respected by medical personnel. Here’s how to fill out the form correctly.

  1. Obtain the New Jersey Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
  2. Read the instructions carefully. Make sure you understand the purpose of the form and the implications of your choices.
  3. Fill in your personal information. This includes your full name, date of birth, and any other required identification details.
  4. Designate a healthcare representative. If you wish, you can name someone who will speak on your behalf regarding your medical care.
  5. Indicate your wishes clearly. There will be a section where you can specify your preferences regarding resuscitation efforts.
  6. Sign and date the form. Your signature is necessary to validate your choices.
  7. Have the form witnessed. New Jersey requires that your signature be witnessed by at least one adult who is not your healthcare representative.
  8. Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and any designated representatives.

Once you have completed the form, it’s important to discuss your decisions with your healthcare provider. They can help ensure that your wishes are clearly understood and documented in your medical records. This way, your preferences can be honored when it matters most.

Key takeaways

Filling out and using the New Jersey Do Not Resuscitate (DNR) Order form is an important step for individuals who wish to make their healthcare preferences known. Here are some key takeaways to keep in mind:

  • The DNR Order form allows individuals to express their wish not to receive cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest.
  • It is crucial to have the form signed by a licensed physician to ensure it is valid and recognized by healthcare providers.
  • The DNR Order must be easily accessible, ideally kept in a location where emergency personnel can find it quickly, such as on the refrigerator or attached to the front of the medical record.
  • Individuals should discuss their decision with family members and caregivers to ensure everyone understands and respects their wishes.
  • Regularly reviewing and updating the DNR Order is important, especially if there are changes in health status or personal preferences.

Understanding these points can help ensure that your healthcare choices are honored when it matters most.

Misconceptions

Understanding the New Jersey Do Not Resuscitate (DNR) Order form is crucial for patients and families making end-of-life decisions. Here are ten common misconceptions about the DNR form that need clarification:

  1. A DNR means that no medical care will be provided. This is incorrect. A DNR specifically addresses resuscitation efforts, not other forms of medical treatment. Patients can still receive necessary medical care, including pain management and comfort measures.
  2. Only terminally ill patients can have a DNR. This is a misconception. Any patient can request a DNR, regardless of their health status, as long as they understand the implications of the order.
  3. A DNR is the same as a living will. While both documents relate to end-of-life care, they serve different purposes. A living will outlines a person’s wishes for medical treatment in various situations, while a DNR specifically addresses resuscitation efforts.
  4. Once a DNR is signed, it cannot be changed. This is not true. Patients can revoke or modify a DNR order at any time, as long as they are competent to make decisions.
  5. Healthcare providers will ignore a DNR order. This misconception undermines the legal validity of DNR orders. Healthcare providers are required to honor a valid DNR order, as it reflects the patient’s wishes.
  6. A DNR applies in all situations. A DNR order is specific to resuscitation in the event of cardiac arrest. It does not apply to other medical emergencies or situations where a patient may need different forms of intervention.
  7. Family members can override a DNR order. Family members cannot unilaterally override a valid DNR order. The order reflects the wishes of the patient and must be respected by healthcare providers.
  8. A DNR order is only for patients in hospitals. This is misleading. A DNR can be applicable in various settings, including at home or in long-term care facilities, as long as it is properly documented.
  9. Only doctors can issue a DNR order. While physicians typically complete the DNR form, patients can also express their wishes for a DNR, which must then be documented by a healthcare provider.
  10. A DNR form is difficult to understand. The New Jersey DNR form is designed to be straightforward. It includes clear language that outlines the patient’s wishes regarding resuscitation efforts.

Preview - New Jersey Do Not Resuscitate Order Form

New Jersey Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order (DNR) is executed in accordance with New Jersey state law regarding end-of-life care and medical decision-making. It is essential for individuals wishing to express their preferences regarding resuscitation efforts in medical emergencies.

Patient Information:

  • Patient Name: ___________________________________
  • Date of Birth: ________________________________
  • Address: _______________________________________
  • Phone Number: ________________________________

Medical Directive:

I, the undersigned, voluntarily and of my own free will, hereby declare that I do not wish to have cardiopulmonary resuscitation (CPR) or other resuscitative measures administered to me in the event of a cardiac arrest or respiratory failure.

Effective Date:

  • Date of Implementation: ______________________

Healthcare Provider(s):

  • Primary Physician: ___________________________
  • Phone Number: ________________________________

This order remains valid unless revoked or altered. Family members and healthcare providers should be informed of its existence.

Signatures:

  • Patient’s Signature: ___________________________
  • Date: ______________________________________
  • Witness Signature: ___________________________
  • Date: ______________________________________

By signing this document, I acknowledge that I understand my rights regarding this Do Not Resuscitate Order and the implications of withholding resuscitative measures.

Let this document serve as a guide for my medical care preferences.

PDF Form Specifics

Fact Name Description
Definition A New Jersey Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Governing Law The DNR Order in New Jersey is governed by the New Jersey Advance Directives for Health Care Act, specifically N.J.S.A. 26:2H-53 to 26:2H-61.
Eligibility Any adult who is capable of making their own medical decisions can complete a DNR Order in New Jersey.
Signature Requirement The DNR Order must be signed by the patient, or by a legally authorized representative if the patient is unable to sign.
Medical Provider's Role Healthcare providers must honor a valid DNR Order. They are legally obligated to follow the instructions outlined in the document.
Form Availability The DNR Order form can be obtained from healthcare providers, hospitals, or online resources provided by the state of New Jersey.
Revocation A DNR Order can be revoked at any time by the patient or their authorized representative. This can be done verbally or in writing.
Emergency Medical Services Emergency medical services (EMS) personnel must have a copy of the DNR Order on file or presented at the scene to adhere to the patient's wishes.