42021 3a

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42021 3a

42021 3a

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

42021 3A Datasheet 1 4 Pages MOLEX3 2 13mm 084 Diameter MLX

42021 3aPrint 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. 42021 585 40 Scream Face Png Free Png Images

Doh 3474 pdf New York State Department of Health

Equivalent Molex 42021 2A 42021 3A 42021 4A 42021 6A 3 Pin Male Female

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 Pin Oleh Di GIRLS Potongan Rambut Keriting Rambut Keriting

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 Pin By Leah On Hair Makeup Short Curly Hair Haircuts For Curly Overwatch 2 Overwatch Battle