Doh 5003 form-2026

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The document outlines the New York State Department of Health's policy regarding Do Not Resuscitate (DNR) orders and Medical Orders for Life-Sustaining Treatment (MOLST). It introduces the approved MOLST form, which serves as an alternative to the Nonhospital Order Not to Resuscitate, detailing patient preferences for end-of-life care. The policy also explains the Family Health Care Decisions Act, which allows designated individuals to make healthcare decisions for patients unable to do so. Key differences between DNR and MOLST forms are highlighted, including their intended use and legal recognition.

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Click ‘Get Form’ to open the DOH-5003 form in the editor.
Begin with Section A, where you will select either 'CPR Order' or 'DNR Order'. Ensure only one box is checked to indicate the patient's resuscitation preferences.
Move to Section B and indicate who consented to the resuscitation instructions. Fill in the name of the decision-maker and ensure their signature is included.
In Section C, a physician must sign and print their name, confirming the orders in Sections A and B are valid.
Proceed to Section D to check any advance directives that apply, such as Health Care Proxy or Living Will.
In Section E, specify orders for other life-sustaining treatments. Check appropriate options regarding intubation, hospitalization, and nutrition.
Finally, review all sections for accuracy before saving or printing your completed form.

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