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Free Do Not Resuscitate Order Template for New Jersey

A New Jersey Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form is particularly important for those who wish to avoid aggressive life-saving measures when facing terminal illness or severe medical conditions. Understanding the DNR form can help ensure that your healthcare preferences are respected during critical moments.

Form Sample

New Jersey Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is made pursuant to New Jersey laws, specifically N.J.S.A. 26:2H-86 to 26:2H-100.

Patient Information

  • Patient's Name: ____________________________
  • Date of Birth: ____________________________
  • Address: ________________________________
  • Phone Number: ____________________________

Healthcare Proxy Information

  • Name of Healthcare Proxy: ____________________________
  • Relationship to Patient: ____________________________
  • Phone Number: ____________________________

Order Statement

I, the undersigned patient, hereby direct that in the event of my cardiac arrest or respiratory arrest, resuscitation measures such as cardiopulmonary resuscitation (CPR) will not be initiated.

This decision is made voluntarily, and I understand its implications.

Signatures

  • Patient's Signature: ____________________________ Date: _______________
  • Witness Signature: ____________________________ Date: _______________

This DNR Order is valid when completed and signed by the patient and a witness.

Misconceptions

Understanding the New Jersey Do Not Resuscitate (DNR) Order form is crucial for making informed healthcare decisions. However, several misconceptions can lead to confusion. Here are seven common misunderstandings:

  1. A DNR means that no medical care will be provided. Many believe that having a DNR in place means a patient will receive no medical care at all. In reality, a DNR only indicates that CPR should not be performed in the event of cardiac arrest. Other medical treatments and interventions can still be administered.
  2. A DNR is 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 circumstances. It’s a personal choice that can apply to various health situations.
  3. A DNR is permanent and cannot be changed. Some think that once a DNR is established, it cannot be altered. In fact, individuals can change or revoke their DNR orders at any time, as long as they are mentally competent to do so.
  4. Emergency responders will ignore a DNR order. There is a concern that emergency personnel may not respect a DNR order. However, trained responders are required to follow the DNR directive if it is properly documented and presented during an emergency.
  5. Having a DNR means giving up on life. Many people fear that opting for a DNR signifies a lack of hope. In truth, it reflects a thoughtful decision about the type of care a person wants, focusing on quality of life rather than aggressive interventions.
  6. A DNR order is the same as a living will. A DNR order specifically addresses resuscitation efforts, while a living will outlines broader healthcare preferences. Both documents are important but serve different purposes in advance care planning.
  7. Only doctors can initiate a DNR order. While healthcare providers often assist in the process, individuals can express their wishes regarding resuscitation to their doctors. The order must be formally documented, but the conversation can begin with the patient.

By clarifying these misconceptions, individuals can better navigate their healthcare choices and ensure their preferences are respected.

Key takeaways

Filling out and using the New Jersey Do Not Resuscitate Order (DNR) form requires careful consideration. Below are key takeaways to keep in mind:

  • The DNR form must be completed by a physician and signed by the patient or their authorized representative.
  • It is essential to ensure that the form is readily accessible in emergency situations, as first responders rely on it to guide their actions.
  • Patients should discuss their wishes with family members and healthcare providers to ensure that everyone understands the implications of the DNR order.
  • The DNR order can be revoked at any time by the patient or their representative, and it is important to communicate any changes to healthcare providers.

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