Fillable Online health utah Provider Order for Life-Sustaining ... 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's last name, first name, middle initial, date of birth, and last four digits of their Social Security number in the designated fields.
3. Fill in the effective date of this order and the patient's address (street, city, state, zip).
4. Provide the medical provider's name and phone number. This section is crucial as it identifies who is responsible for the order.
5. In Section A, select one option regarding cardiopulmonary resuscitation (CPR) preferences. Ensure you understand the implications of each choice.
6. Proceed to Section B to choose medical interventions based on whether the patient has a pulse and is breathing. Carefully review each option before making a selection.
7. Complete Section C regarding artificial nutrition preferences. Indicate if a trial period is desired or if no artificial nutrition is preferred.
8. If applicable, fill out Section D concerning advance directives and patient preferences. Ensure all required signatures are obtained for validity.

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