12 5 Cm Na Mm

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12 5 Cm Na Mm

12 5 Cm Na Mm

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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12 5 Cm Na MmPrint 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. Tapeta Wallcolors Owl Lady Dekorujsciany Millimeters Cartoons Illustrations Vector Stock Images 430

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 A Mid century Table Lamp Chromed Metal And Glass Circa 1970 H 37 X

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 Brinco MiniBolinha Yasmin Hikari Uzupe nij A 1cm mm wi c 1cm mm B 1dm cm wi c 1dm