5 5 Z 70000

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5 5 Z 70000

5 5 Z 70000

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 5 Z 70000Print 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. 107409416 17146559732024 04 17t034316z 1255444960 rc2387aup3a6 rtrmadp Trump Charged In Hush Money Indictment With Conspiracy False Records

Doh 3474 pdf New York State Department of Health

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 107382581 17096589542024 03 05t171307z 746103105 rc2pf6aga3b2 rtrmadp 0

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 108022259 17240904262024 08 19t175033z 501754141 rc20j9ap4u2e rtrmadp 0 107409037 17145892582024 05 01t184544z 1052945606 rc2uh7a3ktmz rtrmadp