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Begin by filling out Section A. Enter the patient's last name, first name, middle initial, date of birth, last four digits of their SSN, and gender. Choose one option for Cardiopulmonary Resuscitation (CPR) based on the patient's wishes.
Move to Section B to specify medical interventions. Select either 'Full Treatment', 'Limited Interventions', or 'Comfort-focused Care' based on the patient's preferences for care.
In Section C, indicate preferences regarding medically administered fluids and nutrition. Choose from options like feeding tube long-term or no IV fluids.
Section D allows you to select antibiotic preferences. Check the appropriate box based on clinical indications.
Finally, complete Section E by discussing these orders with relevant parties and obtaining necessary signatures from the patient or their representative.
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