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Click ‘Get Form’ to open the DNR form in our editor.
Begin by entering the patient's full legal name, date of birth, and gender in the designated fields at the top of the form.
Select one of the four boxes (A, B, C, or D) based on who is completing the form. If you choose Box A, ensure that you sign and date it as a competent adult making an informed decision.
If using Box B or C for a patient unable to make decisions, provide your relationship to the patient and complete all required signatures.
Witnesses must sign in the designated areas. Ensure that two witnesses are present unless completed by two physicians under Box D.
Finally, have the attending physician complete their statement and signature if applicable. Review all entries for accuracy before saving.
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