5 10 X 40

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5 10 X 40

5 10 X 40

5 10 X 40

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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5 10 X 40Print 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. Leupold 3 5 10x40 Mark 4 LR T M2 Side Focus Riflescope 67940 B H 2 5 10 X 40 Tactical Rifle Scope With Red Laser Dual Illuminated Mil

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 BUSHNELL ELITE 4500 PRECISION 2 5 10 X 40 RIFLE SCOPE Switzer s

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 BUSHNELL ELITE 4500 PRECISION 2 5 10 X 40 RIFLE SCOPE Switzer s Leupold Vari X III 3 5 10 X 40 MM Scope Used

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UUQ 2 5 10x40EG Green Laser Rifle Scope With Red Green Illuminated Mil

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UUQ 2 5 10x40IR Rifle Scope With Red Illuminated Mil dot With Red Lase

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BUSHNELL ELITE 4500 PRECISION 2 5 10 X 40 RIFLE SCOPE Switzer s

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BUSHNELL ELITE 4500 PRECISION 2 5 10 X 40 RIFLE SCOPE Switzer s

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UUQ 2 5 10x40EG Green Laser Rifle Scope With Red Green Illuminated Mil

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