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Ohio Laws and Rules
(A) The following items are approved as DNR identification:
(1) A do-not-resuscitate order documented on the form depicted in appendix A of this rule. This form may be reproduced as needed;
(2) Documentation on the form depicted in appendix A of this rule that the person named on the form has executed a declaration that authorizes the withholding or withdrawal of CPR and that has not been revoked pursuant to section 2133.04 of the Revised Code and that the declaration has become operative in accordance with section 2133.03 of the Revised Code;
(3) A transparent hospital-type bracelet with an insert as depicted in appendix B of this rule;
(4) A necklace bearing both the logo depicted in appendix C of this rule and the person’s name that is manufactured in accordance with specifications issued by the director of health. The director shall provide in the specifications that the necklaces shall be of uniform size and design. If the person is a “DNR Comfort Care – Arrest” patient as specified in rule 3701-62-05 of the Administrative Code, the necklace shall include the word “arrest” under the logo;
(5) A bracelet bearing both the logo depicted in appendix C of this rule and the person’s name that is manufactured in accordance with specifications issued by the director of health. When issuing specifications for bracelets under this paragraph, the director shall ensure that the bracelets are of uniform size and design. If the person is a “DNR Comfort Care – Arrest” patient as specified in rule 3701-62-05 of the Administrative Code, the bracelet shall include the word “arrest” under the logo;
(6) A wallet card as depicted in appendix D of this rule. This card may be reproduced as needed; and
(7) A printed form of a declaration sold or otherwise distributed in accordance with section 2133.07 of the Revised Code, if the declarant specifies on the form that the declarant wishes to use it as DNR identification.
(B) A person is eligible to obtain DNR identification if either of the following circumstances exist:
(1) The person has executed a declaration that authorizes the withholding or withdrawal of CPR and that has not been revoked pursuant to section 2133.04 of the Revised Code, and the declaration has become operative in accordance with section 2133.03 of the Revised Code; or
(2) The person’s attending physician, or CNP or CNS as provided in rule 3701-62-02 of the Administrative Code, has issued a current do-not-resuscitate order, in accordance with the do-not-resuscitate protocol specified in rule 3701-62-05 of the Administrative Code, for that person, and has documented the grounds for the order in that person’s medical record. The do-not-resuscitate order itself may be used as DNR identification if it is documented on the form depicted in appendix A of this rule.
(C) A person may obtain DNR identification in the following manner:
(1) In the case of the form specified in paragraphs (A)(1) and (A)(2) of this rule, by obtaining a copy of the form from a physician, CNP, CNS, or health care facility and completing the form in conjunction with the person’s attending physician, or CNP or CNS as provided in rule 3701-62-02 of the Administrative Code.
(2) In the case of the wallet card specified in paragraph (A)(6) of this rule, by doing both of the following:
(a) Obtaining both the form specified in paragraph (A)(1) of this rule and the wallet card from a physician, CNP, CNS, or health care facility; and
(b) Completing both the form and card in conjunction with the person’s attending physician, or CNP or CNS as provided in rule 3701-62-02 of the Administrative Code.
(3) In the case of the hospital-type bracelet specified in paragraph (A)(3) of this rule, by doing both of the following:
(a) Obtaining a DNR order from the person’s attending physician, or CNP or CNS as provided in rule 3701-62-02 of the Administrative Code; and
(b) Acquiring a bracelet containing a completed insert from a physician, CNP, CNS, health care facility, or pharmacy. The physician, CNP, CNS, facility, or pharmacy shall not issue a bracelet to the person unless the person presents a DNR order.
(4) In the case of the necklace specified in paragraph (A)(4) of this rule and the bracelet specified in paragraph (A)(5) of this rule, by doing both of the following:
(a) Obtaining a DNR order from the person’s attending physician, or CNP or CNS as provided in rule 3701-62-02 of the Administrative Code; and
(b) Acquiring a necklace or bracelet from a person or government entity that manufactures or distributes it. The order for the necklace or bracelet shall be accompanied by a copy of the DNR order.
(5) In the case of a declaration form specified in paragraph (A)(7) of this rule, by obtaining and completing the form in the manner required by sections 2133.01 to 2133.15 of the Revised Code and specifying on the form that the declarant wishes to use it as DNR identification. If the declarant wishes to be a “DNR Comfort Care – Arrest” patient, as specified in rule 3701-62-05 of the Administrative Code, the declarant shall include a statement in the declaration that in the event of a cardiac arrest or a respiratory arrest, the declarant is not to receive CPR.
Appendix A DNR Comfort Care
DNR Identification Form
DNRCC
(If this box is checked the DNR Comcort Care Protocol is activated immediately.)
DNRCC-Arrest
(If this box is checked, the DNR Comfort Care Protocol is implemented in the event of a cardiac arrest or a respiratory arrest.)
Patient Name:_____________________________________
Address:__________________________________________
City_________________________ State______________ Zip__________
Birthdate________________________ Gender M F
Signature_________________________________________ (optional)
Certification of DNR Comfort Care Status (to be completed by the physician)
(Check only one box)
Do-Not-Resuscitate Order-My signature below constitutes and confirms a formal order to emergency medical services and other health care personnel that the person identified above is to be treated under the State of Ohio DNR Protocol. I affirm that this order is not contrary to reasonable medical standards or, to the best of my knowledge, contrary to the wishes of the person or of another person who is lawfully authorized to make informed medical decisions on the person’s behalf. I also affirm that I have documented the grounds for this order in the person’s medical record.
Living Will (Declaration) and Qualifying Condition-The person identified above has a valid Ohio Living will (declaration) and has been certified by two physicians in accordance with Ohio law as being terminal or in a permanent unconscious state, or both.
Printed name of physician
*:______________________________
Signature _________________________________ Date_________________________________
Address:__________________________________________ Phone__________________________
City/State________________________________________ Zip______________________________
*
A DNA order may be issued by a certified nurse practitioner or clinical nurse specialist when authorized by section 2133.211 of the Ohio Revised Code.
See reverse side for DNR Protocol
Do not resuscitate comfort care protocol
After the State of Ohio DNR Protocol has been activated for a specific DNR Comfort Care patient, the Protocol specifies that emergency medical services and other health care workers are to do the following:
Will:
Will not:
:”3701-62-04”>* Initiate cardiac monitoring
If you have responded to an emergency situation by initiating any of the will notactions prior to confirming that the DNR Comfort Care Protocol should be activated, discontinue them when you activate the Protocol. You may continue respiratory assistance, IV medications, etc., that have been part of the patient’s ongoing course of treatment for an underlying disease.
R.C. 119.032 review dates: 04/30/2004 and 04/30/2009
Promulgated Under: 119.03
Statutory Authority: 2133.25
Rule Amplifies: 2133.25
Prior Effective Dates: 5/20/1999