23200 4a001

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23200 4a001

23200 4a001

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

23200 4A001 D4CB

23200 4a001Print 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. 2320027100 MT2 0L D4EA LUK 23200 ISO IEC 23200 2 2023 IEC Standards VDE Publishing House

Doh 3474 pdf New York State Department of Health

VOLANTE MOTOR 23200 4A001

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 High MOUNT 23200

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 Landmann 23200 Parts Grills Morral Ejecutivo Porta PC 14 Adelaide 1 2 0 Negro Mujer