7x 5 49

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7x 5 49

7x 5 49

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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7x 5 49Print 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. Taylor Swift Moves Up Eras Tour Movie Release Date Heads To Premiere 107274392 16898733502023 07 20t171318z 1352407551 rc2572adwi5v 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 107361037 17055870662024 01 18t102403z 838136397 rc2ak5a86bbx 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 107197034 1676853416494 gettyimages 1467562529 006 1ca9df8e 5463 4203 Autotalli 2 7x 5 1m 500g m2 Peite Galvanoitu Ter srunko Takuu 1v