10 240 Simplified

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10 240 Simplified

10 240 Simplified

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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10 240 SimplifiedPrint 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. UK PM Rishi Sunak To Propose Compulsory Math Up To The Age Of 18 House Ousts Kevin McCarthy As Speaker A First In U S History

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 108043622 17280677422024 10 04t183003z 910478354 rc2udaanw3mc rtrmadp 0

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 107350563 17031713842019 10 22t041340z 2007208486 rc14ac6e7600 rtrmadp 107312005 16965102302023 10 04t205456z 1729187630 rc2sl3ax6qrl rtrmadp