58503b

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58503b

58503b

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

HP 58503B Nubicom

58503bPrint 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. HP Z3805A Time Frequency GPS Receiver Yahoo HP 58503B Time And Frequency Reference Receiv

Doh 3474 pdf New York State Department of Health

58503B GPS

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 1PC USED HP Symmetricom 58503B GPS by EMS Or DHL 90days Warranty

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 HP Z3805A Time Frequency GPS Receiver Hewlett Packard 58532A GPS L1 Antenna Hewlett Packard 58503B GPS Time