Nonhospital Order Not to Resuscitate NEW YORK STATE ...
NEW YORK STATE DEPARTMENT OF HEALTH Person’s Name: Date of Birth: Do not resuscitate the person named above. *Physician/Nurse Practitioner/ Physician Assistant Signature: Print Name: License Number: Date: It is the responsibility of the physician/nurse practitioner/physician assistant to determine, at least every 90 days, whether this order
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