Court Opinions

State Laws

US Code

US Constitution

Orders, bracelets and necklaces - 20 Pa. Cons. Stat. § 5484

Legal Research Home > Pennsylvania Statutes

     § 5484.  Orders, bracelets and necklaces.
        (a)  Issuance.--An attending physician, upon the request of a
     patient who is at least 18 years of age, has graduated from high
     school, has married or is an emancipated minor, or the patient's
     surrogate if the surrogate is so authorized, shall issue to the
     patient an order and may issue at the request of the patient or
     the patient's surrogate a bracelet or necklace supplied by the
     department. The patient may, at the patient's option, wear the
     bracelet or display the order or necklace to notify emergency
     medical services providers of the patient's DNR status.
        (b)  Format of order.--The department shall, with the advice
     of the Pennsylvania Emergency Health Services Council and with
     the assistance of the regional emergency medical services
     councils, make available standard orders for issuance to
     patients by attending physicians of this Commonwealth. The form
     of the order shall contain, but not be limited to, the
     following:
                          PENNSYLVANIA OUT-OF-HOSPITAL
                            DO-NOT-RESUSCITATE ORDER
            Patient's full legal name:
                I, the undersigned, state that I am the attending
            physician of the patient named above. The above-named
            patient or the patient's surrogate has requested this
            order, and I have made the determination that the patient
            is eligible for an order and satisfies one of the
            following:
                .......... has an end-stage medical condition.
                .......... is permanently unconscious and has a
            living will directing that no cardiopulmonary
            resuscitation be provided to the patient in the event of
            the patient's cardiac or respiratory arrest.
                I direct any and all emergency medical services
            personnel, commencing on the effective date of this
            order, to withhold cardiopulmonary resuscitation (cardiac
            compression, invasive airway techniques, artificial
            ventilation, defibrillation and other related procedures)
            from the patient in the event of the patient's
            respiratory or cardiac arrest. I further direct such
            personnel to provide to the patient other medical
            interventions, such as intravenous fluids, oxygen or
            other therapies necessary to provide comfort care or to
            alleviate pain, unless directed otherwise by the patient
            or the emergency medical services provider's authorized
            medical command physician.
                Signature of attending physician:
                Printed name of attending physician:
                Dated:
                Attending physician's emergency telephone number:
                I, the undersigned, hereby direct that in the event
            of my cardiac and/or respiratory arrest efforts at
            cardiopulmonary resuscitation not be initiated and that
            they may be withdrawn if initiated. I understand that I
            may revoke these directions at any time by giving verbal
            instructions to the emergency medical services providers,
            by physical cancellation or destruction of this form or
            my bracelet or necklace or by simply not displaying this
            form or the bracelet or necklace for my EMS caregivers.
                Signature of patient (if capable of making informed
            decisions):
                I, the undersigned, hereby certify that I am
            authorized to execute this order on the patient's behalf
            by virtue of having been designated as the patient's
            surrogate and/or by virtue of my relationship to the
            patient (specify relationship: .................). I
            hereby direct that in the event of the patient's cardiac
            and/or respiratory arrest efforts at cardiopulmonary
            resuscitation not be initiated and be withdrawn if
            initiated.
                Signature of surrogate (if patient is incapable of
            making informed decisions):
        (c)  Format of bracelet.--The department shall, with the
     advice of the Pennsylvania Emergency Health Services Council and
     with the assistance of the regional emergency medical services
     councils, make available standard bracelets for issuance to
     patients by attending physicians. The bracelets shall be uniform
     in design and shall, at a minimum, on the face clearly indicate
     OUT-OF-HOSPITAL DNR and the name of the patient and attending
     physician as well as the dated signature of the attending
     physician.
        (d)  Format of necklace.--The department shall, with the
     advice of the Pennsylvania Emergency Health Services Council and
     with the assistance of the regional emergency medical services
     councils, make available standard necklaces for issuance to
     patients by attending physicians. The necklaces shall be uniform
     in design and shall, at a minimum, on the face clearly indicate
     OUT-OF-HOSPITAL DNR and the name of the patient and attending
     physician as well as the dated signature of the attending
     physician.

        Cross References.  Section 5484 is referred to in section
     5445, 5483 of this title.

Last modified: November 27, 2007