Official Do Not Resuscitate Order Form for the State of New Hampshire

Official Do Not Resuscitate Order Form for the State of New Hampshire

A Do Not Resuscitate Order (DNR) form in New Hampshire is a legal document that allows individuals to express their wishes regarding medical treatment in the event of a cardiac arrest or respiratory failure. This form ensures that emergency medical personnel understand a patient’s desire to forego resuscitation efforts. If you or a loved one are considering this important decision, take the next step by filling out the form below.

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In New Hampshire, the Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals who wish to express their preferences regarding medical treatment in emergency situations. This form allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures in the event of cardiac or respiratory arrest. It is important for individuals to understand that completing a DNR Order is a personal decision, often made after thoughtful consideration and discussions with healthcare providers and loved ones. The form must be signed by a physician, ensuring that it reflects the patient's wishes and is legally recognized. Additionally, the DNR Order should be readily accessible to emergency medical personnel and healthcare providers, as it guides them in respecting the patient's choices during critical moments. Understanding the implications of this form can empower individuals to take control of their healthcare decisions and ensure that their preferences are honored when they may not be able to communicate them directly.

Example - New Hampshire Do Not Resuscitate Order Form

New Hampshire Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is a legal document that expresses an individual’s wishes regarding resuscitation efforts in the event of a medical emergency. This template complies with New Hampshire laws governing Do Not Resuscitate Orders.

Please fill in the blanks where indicated. Retain a copy for your records, and provide additional copies to your healthcare providers.

Patient Information:

  • Patient's Full Name: ____________
  • Date of Birth: ____________
  • Patient's Address: ____________

Health Care Provider Information:

  • Primary Physician's Name: ____________
  • Primary Physician's Contact Number: ____________

Consent Signature:

I, the undersigned, hereby declare that I understand the nature and purpose of this DNR order. I affirm that I am making this decision voluntarily and without coercion.

Signature of Patient or Legal Representative: ____________

Date: ____________

Witness Information:

  • Name of Witness: ____________
  • Signature of Witness: ____________
  • Date: ____________

For healthcare professionals: This DNR Order should be placed in the patient’s medical record. Follow appropriate protocols to ensure that the patient’s wishes are respected in any emergency situation.

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What is a Do Not Resuscitate (DNR) Order in New Hampshire?

A Do Not Resuscitate Order is a legal document that allows a person to refuse cardiopulmonary resuscitation (CPR) and other life-saving measures in the event of cardiac or respiratory arrest. In New Hampshire, this order is typically used by individuals who have a terminal illness or are nearing the end of life. It ensures that their wishes regarding medical treatment are respected by healthcare providers in emergency situations.

Who can complete a DNR Order in New Hampshire?

In New Hampshire, a DNR Order can be completed by an adult who is capable of making their own healthcare decisions. This individual must be fully informed about the implications of the order. Additionally, a physician must sign the DNR form to validate it. If the individual is unable to make decisions, a legally authorized representative, such as a family member or healthcare proxy, may complete the order on their behalf.

How do I obtain a DNR Order form in New Hampshire?

You can obtain a DNR Order form from your healthcare provider or download it from the New Hampshire Department of Health and Human Services website. It is important to ensure that the form is filled out correctly and signed by both you and your physician. This will help avoid any confusion or disputes regarding your wishes in a medical emergency.

What should I do after completing a DNR Order?

After you have completed and signed your DNR Order, it is crucial to share copies of the document with your healthcare providers, family members, and anyone else involved in your care. Keeping a copy in a prominent place, such as on your refrigerator or with your medical records, can also be helpful. This way, emergency responders and medical personnel can easily access your wishes when necessary.

Can I change or revoke my DNR Order?

Yes, you can change or revoke your DNR Order at any time as long as you are competent to make your own healthcare decisions. To revoke the order, simply inform your healthcare provider and any family members or caregivers involved in your care. It is advisable to complete a new DNR form if you wish to make changes to your existing order, ensuring that all parties are aware of your updated wishes.

Misconceptions

Understanding the New Hampshire Do Not Resuscitate (DNR) Order form can be challenging. Here are five common misconceptions about this important document:

  1. Misconception 1: A DNR order means you will not receive any medical care.

    This is not true. A DNR order specifically addresses resuscitation efforts in the event of a cardiac or respiratory arrest. You will still receive all other necessary medical treatments and interventions.

  2. Misconception 2: DNR orders are only for terminally ill patients.

    While many people associate DNR orders with terminal illness, they can be appropriate for anyone who wishes to avoid resuscitation in specific situations. It's a personal decision based on individual values and preferences.

  3. Misconception 3: A DNR order is permanent and cannot be changed.

    In fact, a DNR order can be revoked or modified at any time. If your wishes change or if you feel differently about resuscitation, you can update your DNR order accordingly.

  4. Misconception 4: You need a lawyer to complete a DNR order.

    This is a common belief, but it's not necessary. Individuals can fill out the DNR order form themselves. However, discussing your wishes with a healthcare provider can be beneficial.

  5. Misconception 5: DNR orders are only valid in hospitals.

    DNR orders are valid in various settings, including at home and in long-term care facilities. It’s essential to ensure that your DNR order is properly documented and communicated to your healthcare providers.

By clearing up these misconceptions, individuals can make informed decisions about their healthcare preferences and ensure their wishes are respected.

Similar forms

  • Living Will: This document outlines a person's wishes regarding medical treatment in situations where they cannot communicate. Like a DNR, it focuses on end-of-life care preferences.
  • Advance Healthcare Directive: This legal document allows individuals to specify their healthcare preferences and appoint a representative to make decisions on their behalf, similar to the intent of a DNR.
  • Healthcare Proxy: A healthcare proxy designates someone to make medical decisions for an individual if they become incapacitated. This can align with the wishes expressed in a DNR.
  • Power of Attorney for Healthcare: This document gives someone authority to make healthcare decisions for another person, often including preferences about resuscitation and life support.
  • Do Not Intubate Order: Similar to a DNR, this order specifically instructs healthcare providers not to place a breathing tube in case of respiratory failure.
  • POLST (Physician Orders for Life-Sustaining Treatment): This form provides specific medical orders regarding treatment preferences, including resuscitation, and is similar in intent to a DNR.
  • Comfort Care Order: This document focuses on providing comfort rather than curative treatment, aligning with the goals of a DNR to avoid aggressive interventions.
  • Do Not Hospitalize Order: This order indicates that a patient should not be admitted to a hospital for treatment, reflecting similar end-of-life care preferences as a DNR.
  • Last Will and Testament: A Last Will and Testament form ensures the distribution of a person’s assets according to their wishes, and more information can be found at smarttemplates.net.
  • Advance Directive for Mental Health Treatment: This document allows individuals to express their treatment preferences for mental health care, paralleling the intent of a DNR in specifying care wishes.
  • End-of-Life Care Plan: This plan outlines a person's wishes for care during the final stages of life, similar to a DNR in its focus on avoiding unwanted medical interventions.

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