5ja 867 145 A 9b9

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5ja 867 145 A 9b9

5ja 867 145 A 9b9

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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5ja 867 145 A 9b9Print 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. 107412271 17151910672024 05 07t221049z 117843227 rc2xl7a36yo7 rtrmadp 0 107412289 17151921432024 05 07t012426z 1755337355 rc2cl7a6o2f4 rtrmadp

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 107291658 16928997422023 08 24t161712z 980006164 rc2eu2a7nb0j 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 Alibaba To Launch Local Version Of China E commerce Site Tmall In Europe House Ousts Kevin McCarthy As Speaker A First In U S History