New Mexico Do Not Resuscitate Order (DNR)
This Do Not Resuscitate Order (DNR) is established in accordance with New Mexico state laws regarding advance directives and medical treatment preferences. It is intended to communicate the wishes of the individual regarding resuscitation efforts in the event of cardiac arrest or respiratory failure.
Patient Information:
- Full Name: _______________________________
- Date of Birth: __________________________
- Address: ________________________________
- Phone Number: __________________________
Physician Information:
- Physician's Name: ________________________
- Physician's Phone Number: _______________
Patient's Wishes:
I, the undersigned, hereby declare that I do not wish to receive cardiopulmonary resuscitation (CPR) or other resuscitative measures in the event of cardiac arrest or respiratory failure. I understand that this decision may result in my death.
Signature of Patient or Legal Representative: __________________________
Date: __________________________
Witness Information:
- Witness Name: __________________________
- Witness Signature: ______________________
- Date: ________________________________
This DNR Order should be placed in a visible location and a copy should be provided to all healthcare providers involved in the patient's care.