3 24 42

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3 24 42

3 24 42

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

Dnevnik 3 24 02 2023

3 24 42Print 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. Logo 107426898 1718053001119 gettyimages 2156422157 AFP 34WB24M jpeg v

Doh 3474 pdf New York State Department of Health

Dnevnik 3 24 03 2023

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 STYLE KREAM

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 VIT3 24 Vite E Dado Inox Per ART T3 24 Vicrox 107268605 1688904376431 gettyimages 1515204304 AFP 33NA24D jpeg v