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Do not hospitalize order form pdf 2025

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The document is a 'Do Not Hospitalize Order' in which an individual expresses their desire to avoid hospitalization for medical conditions that can be treated at home or in a care facility. It outlines conditions under which hospitalization may occur, emphasizing comfort and pain management rather than aggressive treatment. The individual acknowledges their understanding of the directive and retains the right to revoke it at any time.

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Click ‘Get Form’ to open the do not hospitalize order form in the editor.
Begin by filling in your full name in the designated field, ensuring it matches your legal identification.
Provide your address, including city, state, and zip code, to ensure accurate documentation.
In the section regarding hospitalization preferences, clearly indicate your wishes by checking the appropriate boxes as per your directives.
Sign and date the document at the bottom. Ensure that you are in a position to understand and acknowledge this decision.
If required, have witnesses sign their names and provide their addresses in the specified fields.
Complete any necessary notarization if mandated by state law by filling out the acknowledgment section.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is included in a DNR form?

A DNR order allows you to choose whether or not you want CPR in an emergency. It is specific about CPR. It does not have instructions for other treatments, such as pain medicine, other medicines, or nutrition.

Can I print out a DNR form?

Download, Complete, and Sign. The DNR form should be printed and signed by both the doctor and patient in the presence of two witnesses.

What is a key consideration for a do not hospitalize DNH order?

A do not hospitalize order did not mean that a patient was not to be hospitalized. When an acute event occurred, consideration of the circumstances and discussion with the patient and family were still necessary to determine whether an order against hospitalization should be followed.

What is a do not hospitalize order?

As the name sounds, the do not hospitalize (DNH) order is an advance directive that prohibits relatives or health care providers from admitting a loved one in the hospital if needed.