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Printable Do Not Resuscitate Form Michigan
Printable Do Not Resuscitate Form Michigan -
Do Not Resuscitate The purpose of this policy is to provide a guideline to prehospital providers who under certain circumstances may accommodate patients who do not wish to receive and or may not benefit from cardiopulmonary resuscitation
Witness signature PRINT Witness s name Date mm dd yyyy Witness signature PRINT Witness s name Date mm dd yyyy THIS FORM WAS PREPARED PURSUANT TO AND IN COMPLIANCE WITH THE MICHIGAN DO NOT RESUSCITATE DECLARATION PROCEDURE ACT 1996 PA 193 PROVIDERS PLEASE RETAIN A COPY OF ALL
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DNR Order Michigan Do Not Resuscitate Purpose The purpose of this policy is to provide a guideline to prehospital providers who under certain circumstances may accommodate patients who do not wish to receive and or may not benefit from cardiopulmonary resuscitation
Under Michigan law a do not resuscitate order is a voluntarily signed form by either a person a patient advocate or a guardian The order states that if the person s heart or breathing stops there should be no resuscitation efforts made Resuscitation efforts include mouth to mouth resuscitation cardiopulmonary resuscitation CPR and
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1 Clearly imprinted Do Not Resuscitate Order 2 Name and address of declarant and 3 Name and telephone number of the declarant s attending physician who signed the order DNR Bracelets can be ordered from stickyj This website allows one to order DNR bracelets for the state of MI with specific instructions
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https://www.med.umich.edu/1libr/AdvanceDirectives/...
Witness signature PRINT Witness s name Date mm dd yyyy Witness signature PRINT Witness s name Date mm dd yyyy THIS FORM WAS PREPARED PURSUANT TO AND IN COMPLIANCE WITH THE MICHIGAN DO NOT RESUSCITATE DECLARATION PROCEDURE ACT 1996 PA 193 PROVIDERS PLEASE RETAIN A COPY OF ALL
https://www.michigan.gov/mdhhs/adult-child-serv/...
Yes You may cancel it at any time by any means of communication possible Will My Insurance Coverage Be Affected If I Sign Such An Order No The law says that your insurance provider can t change stop refuse to renew or invoke a suicide exemption or exclusion Haven t Do Not Resuscitate Orders Changed Yes
Witness signature PRINT Witness s name Date mm dd yyyy Witness signature PRINT Witness s name Date mm dd yyyy THIS FORM WAS PREPARED PURSUANT TO AND IN COMPLIANCE WITH THE MICHIGAN DO NOT RESUSCITATE DECLARATION PROCEDURE ACT 1996 PA 193 PROVIDERS PLEASE RETAIN A COPY OF ALL
Yes You may cancel it at any time by any means of communication possible Will My Insurance Coverage Be Affected If I Sign Such An Order No The law says that your insurance provider can t change stop refuse to renew or invoke a suicide exemption or exclusion Haven t Do Not Resuscitate Orders Changed Yes
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