Homepage Attorney-Approved Do Not Resuscitate Order Document Free Do Not Resuscitate Order Template for the State of New Jersey

Form Breakdown

Fact Name Details
Purpose The New Jersey Do Not Resuscitate Order (DNR) form is used to indicate a person's wish not to receive CPR or other resuscitation efforts in case of cardiac or respiratory arrest.
Governing Law The DNR form is governed by the New Jersey Advance Directives for Health Care Act, specifically N.J.S.A. 26:2H-53 to 26:2H-61.
Eligibility Any adult who is capable of making their own healthcare decisions can complete a DNR order.
Signature Requirement The DNR form must be signed by the patient and a physician to be valid.
Emergency Medical Services Emergency medical personnel are required to honor a valid DNR order in the field.
Revocation A DNR order can be revoked at any time by the patient or their authorized representative.

Sample - New Jersey Do Not Resuscitate Order Form

New Jersey Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order, created in accordance with New Jersey state law, allows individuals to specify their preferences regarding resuscitative measures in the event of a medical emergency.

Patient Information:

  • Name: _____________________________
  • Date of Birth: _____________________
  • Address: __________________________

Health Care Representative:

  • Name: _____________________________
  • Phone Number: ____________________
  • Relationship to Patient: ___________

Order Details:

  1. The patient has chosen not to receive cardiopulmonary resuscitation (CPR) or other resuscitative measures in the event of a cardiac arrest.
  2. The healthcare providers are instructed to honor this decision and refrain from initiating resuscitation.

Signature:

  • Patient or Legal Representative Signature: _____________________________
  • Date: ______________________

Witness Signature:

  • Name: _____________________________
  • Date: ______________________

This document, once signed, will guide healthcare providers in alignment with the patient's wishes.

Common mistakes

Filling out the New Jersey Do Not Resuscitate Order (DNR) form can be a significant decision for individuals and their families. However, mistakes during this process can lead to confusion and unintended consequences. One common mistake is failing to clearly indicate the patient's wishes. If the form is not filled out completely or legibly, medical personnel may not understand the intent, leading to unwanted resuscitation efforts.

Another frequent error involves not having the form signed by the appropriate parties. In New Jersey, the DNR form must be signed by the patient or their legal representative. If the signature is missing or if the individual signing is not authorized, the form may not be valid. This can create complications during a medical emergency when timely decisions are crucial.

People often overlook the importance of discussing their wishes with family members and healthcare providers. Without these conversations, loved ones may be unaware of the patient’s preferences, which can lead to disputes or confusion at critical moments. Ensuring that everyone involved understands the DNR order is essential for honoring the patient’s wishes.

Additionally, individuals sometimes forget to keep the DNR form accessible. It should be stored in a location where it can be easily found by medical personnel, such as on the refrigerator or with other important documents. If the form is not readily available when needed, it may not be honored, resulting in unnecessary medical interventions.

Lastly, failing to review and update the DNR order regularly can pose a problem. Life circumstances change, and so may a person’s preferences regarding resuscitation. Regularly revisiting the DNR form ensures that it reflects current wishes and remains valid. Keeping the document updated helps prevent misunderstandings and ensures that healthcare providers are aware of the patient’s intentions.