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3 X 4 5 X 11 12
3 X 4 5 X 11 12
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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3 X 4 5 X 11 12Print 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. Tokina AT X 17 35 F4 PRO FX Lens Digital Photography Live Encuentra Las Preposiciones Incorrectas Gram tica
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 2X 3 3X4 5X9
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 4 5 SPEED GEARBOX DRIVESHAFT DIFF OIL SEAL 38 X 58 X 11 17MM FITS X 3 x 1 6 4 2x 3 5 x 1 16 2x 3 3 2x 7 x 2 3x 3 4 5x 3 x x 3 x
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