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1 2 50 10 X 15 47

1 2 50 10 X 15 47

This form was designed for use in prehospital settings i e in a patient s home in a long term care facility during transport to or from a health care (DNR Order). DOH-3474 (8/20). *For individuals with an Intellectual or Developmental Disability (I/DD), the non-hospital DNR must be signed by a physician.

Outside The Hospital Do Not Resuscitate OHDNR Order

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1 2 50 10 X 15 47Print Attending Practitioner Name (required) ... Changing, modifying or revising a DNR/POLST form requires completion of a new DNR/POLST form. Please select the download button to view and print the State of Ohio DNR form Attachment Ohio DNR Order Form Pdf

A printed copy of this order form or other authorized. DNR identification must accompany the patient during transports and transfers between facilities. Chou Flowers Tampons Clear MOSA QUE Le Scrap De Marianne Electric Scooter Wheel Hub 10x2 10x2 125 10x2 50 10x2 25 10x70 6 5

Doh 3474 pdf New York State Department of Health

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Attending Physician Patient s Home if applicable Original DNR form must be kept in patient s primary medical file KEEP IN PROMINENT PLACE DNR ORDER Apple Music El N poles Kiko Avalos Banda La Misma Escuela Por

Print Form Page 2 INSTRUCTIONS FOR ISSUING AN OOH DNR ORDER PURPOSE The Out of Hospital Do Not Resuscitate OOH DNR Order on reverse side complies with EC CONFORT PIR AP 30MM 1 0X1 0 GALVA F ALUM BRANCO 0 38XFIL 2 50 10 Inch Rear Rim Wheel 12mm Axle 50cc 70cc 110cc SSR Coolster Dirt