"DO NOT RESUSCITATE ORDER | ||
NAME OF PATIENT: __________________ | ||
THIS CERTIFIES THAT AN ORDER NOT TO RESUSCITATE HAS BEEN ENTERED ON THE ABOVE-NAMED PATIENT. | ||
SIGNED: __________________ | ||
ATTENDING PHYSICIAN | ||
PRINTED OR TYPED NAME OF ATTENDING PHYSICIAN: __________________ | ||
ATTENDING PHYSICIAN'S TELEPHONE NUMBER: __________________ | ||
DATE: __________________" |
"DO NOT RESUSCITATE ORDER | ||
Patient's name: __________________ | ||
Authorized person's name and telephone number, if applicable: __________________ | ||
Patient's physician's printed name and telephone number: __________________ | ||
Date of order not to resuscitate: __________________" |
Any physician, health care professional, nurse, physician assistant, caregiver, or emergency medical technician shall be authorized to regard such a bracelet, necklace, or notice as a legally sufficient order not to resuscitate in the same manner as an order issued pursuant to this chapter unless such person has actual knowledge that such order has been canceled or consent thereto revoked as provided in this chapter.
OCGA § 31-39-6.1