3 4 X 2 1 2 Nipple

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3 4 X 2 1 2 Nipple

3 4 X 2 1 2 Nipple

3 4 X 2 1 2 Nipple

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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Black Iron Pipe Nipple 3 4 X 2 1 2 Big River Rubber Gasket

3 4 X 2 1 2 NipplePrint 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. Black Iron Pipe Nipple 1 1 4 X 2 1 2 Big River Rubber Gasket 304 Stainless Steel Pipe Nipples SCH 40 Welded 1 4 X 2 1 2 NPT

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 1 8 1inch Threaded Reducer Hex Nipple For Compression Pipe Fittings

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 2 X 2 1 2 Nipple Brass Nipple Reducing Hex 3 4 X 1 2 Brass

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GVN025 250 Bluefin GVN025 250 1 4 X 2 1 2 Galv Nipple

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1 8 1inch Threaded Reducer Hex Nipple For Compression Pipe Fittings

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