New Jersey Do Not Resuscitate (DNR) Order
This Do Not Resuscitate Order is issued in accordance with New Jersey state laws concerning advance directives. It expresses the wishes of the patient regarding resuscitation efforts in the event of cardiac or respiratory arrest.
Please fill in the following information:
- Patient's Full Name: ___________________________
- Date of Birth: ___________________________
- Patient's Address: ___________________________
- Patient's Medical Record Number (if applicable): ___________________________
This DNR order is applicable in the following circumstances:
- The patient is unable to communicate their wishes.
- The patient is in a medical condition that requires consideration for resuscitation efforts.
Please indicate your preference:
- Do Not Resuscitate: I do not wish to receive any resuscitation should my heart or breathing stop.
- Resuscitate: I wish to receive resuscitation should my heart or breathing stop.
Signature of Patient (or designated advocate): ___________________________
Date: ___________________________
Witness Signature: ___________________________
Date: ___________________________
This document should be kept in a safe place and a copy should be provided to your healthcare provider.
Please ensure that this order is honored by all health care professionals. Share it with family members who may be involved in healthcare decisions.