New York’s DOH-3474 is the state’s nonhospital Do Not Resuscitate order, and completing the New York DNR form DOH-3474 takes three things: a signed consent from the patient or an authorized decision-maker, a signature from a licensed clinician, and placement somewhere emergency responders will actually see it. Download the current PDF free from the Department of Health at health.ny.gov/forms/doh-3474.pdf.1New York State Department of Health. DOH-3474 Nonhospital Order Not to Resuscitate Once signed, it carries the force of a medical order under Public Health Law Article 29-CCC and tells EMS, home care staff, and hospice workers not to perform CPR if your heart or breathing stops outside a hospital.
Who Can Sign the Consent
Three categories of people can consent to a nonhospital DNR: the patient, a health care agent acting under a valid health care proxy, or a surrogate chosen under the Family Health Care Decisions Act. Consent can be given orally to the attending practitioner or in writing.2New York State Senate. New York Code PBH 2994-cc – Consent to a Nonhospital Order Not to Resuscitate
New York law presumes every adult has the mental capacity to make medical decisions unless a clinician or court determines otherwise.3New York State Senate. New York Public Health Law 2994-C – Determination of Incapacity If you understand what refusing CPR means during a cardiac or respiratory arrest, you have the capacity to consent.
When a patient lacks capacity and has no health care proxy, a surrogate from the following priority list may consent, taken from the highest available class:4New York State Senate. New York Public Health Law 2994-D – Health Care Decisions for Adult Patients by Surrogates
- A court-appointed guardian authorized to make health care decisions under Mental Hygiene Law Article 81
- A spouse or domestic partner, if not legally separated from the patient
- An adult son or daughter (18 or older)
- A parent
- An adult brother or sister (18 or older)
- A close friend
If no one in a higher class is reasonably available, willing, and able to act, the next class steps in. When a surrogate consents rather than the patient, a second capacity determination must be made by a health or social services practitioner. That extra safeguard does not apply when the patient signs directly.2New York State Senate. New York Code PBH 2994-cc – Consent to a Nonhospital Order Not to Resuscitate
Filling Out the Form
Use the current version from health.ny.gov. An outdated or unofficial copy risks responders questioning the form in an emergency. Print clearly and use legible ink with no stray marks.
The form has two parts the patient’s side needs to complete. The first is patient information: full legal name and date of birth, matching the patient’s identification exactly. The second is the consent section, where the patient, health care agent, or surrogate signs to show voluntary agreement to the order.
After consent, the clinician completes the order itself. The attending physician, nurse practitioner, or physician assistant signs, prints their name, enters their professional license number, and dates the form.1New York State Department of Health. DOH-3474 Nonhospital Order Not to Resuscitate Once the clinician signs, the document is an active medical order.
One restriction is worth flagging. For a patient with an intellectual or developmental disability, only a physician may sign. A nurse practitioner or physician assistant cannot.1New York State Department of Health. DOH-3474 Nonhospital Order Not to Resuscitate The form itself notes this.
The attending practitioner also has to record the order in the patient’s medical record.5New York State Senate. New York Public Health Law 2994-DD – Managing a Nonhospital Order Not to Resuscitate If you are working with a home hospice team or home care agency, confirm with the practitioner that this step has been done.
Where to Keep the Signed Form
A signed DOH-3474 only works if responders can find it. The standard recommendation is to post the original on the front of the refrigerator, the first place EMS personnel are trained to check when entering a home. For a bedridden patient, the bedside works too. Keeping the form in a drawer or filing cabinet defeats its purpose: responders who cannot quickly confirm a valid DNR are trained to begin resuscitation.
Print extra copies for travel within New York. A new form is not required each time; the original order stays valid unless revoked. Keeping a copy in a purse, wallet, or travel bag means the directive goes with the patient.
DNR Bracelets
New York law lets a patient with a nonhospital DNR wear a standard bracelet or other identifying article, but no one can require it, and no facility or provider can refuse to honor the DNR because the patient is not wearing one.5New York State Senate. New York Public Health Law 2994-DD – Managing a Nonhospital Order Not to Resuscitate The bracelet is an alert that a signed order exists, not a substitute for the form. EMS personnel who spot the bracelet will still look for the signed DOH-3474 before withholding CPR.
How Responders Will Handle It
When EMS, home care staff, hospice workers, or hospital emergency staff see a valid DOH-3474 or the standard bracelet, they must comply with the order and withhold CPR.6New York State Senate. New York Public Health Law 2994-EE – Obligation to Honor a Nonhospital Order Not to Resuscitate That means no chest compressions and no artificial ventilation. Comfort care continues.
The law gives responders only three grounds to disregard the order:
- A good-faith belief that consent has been revoked or the order cancelled
- A scene-safety concern, where family or others present object and a physical confrontation appears likely
- Exceptional medical circumstances, in which a hospital emergency physician, nurse practitioner, or physician assistant directs that the order be overridden
Keeping the Order Current, and Revoking It
The attending practitioner is required to review whether the DNR is still appropriate at each examination, and at minimum every 90 days. The review does not have to happen more than once every seven days even if the patient is seen frequently, and each review goes in the medical record.5New York State Senate. New York Public Health Law 2994-DD – Managing a Nonhospital Order Not to Resuscitate
A missed review does not invalidate the order. The statute explicitly says failure to comply with the review schedule does not render the DNR ineffective. Some online sources claim otherwise; the law is clear that the order stays in force. Keeping up with the review is still worthwhile because it is a built-in chance to confirm the order still reflects the patient’s wishes.
Consent can be revoked at any time through any act showing clear intent: telling a doctor or nurse, physically destroying the form, or any other unambiguous action.5New York State Senate. New York Public Health Law 2994-DD – Managing a Nonhospital Order Not to Resuscitate A health care agent or surrogate who originally consented can also revoke. Any healthcare professional who learns of a revocation must notify the attending practitioner, who cancels the order in the medical record and makes a reasonable effort to collect the form and any bracelet. If the patient changes their mind during an emergency and communicates that to responders on scene, responders should treat the revocation as valid and begin resuscitation.
When DOH-3474 Is Not the Right Form
DOH-3474 covers CPR only. If you also want to address intubation, mechanical ventilation, or other life-sustaining treatments, DOH-3474 will not do that work. The Medical Orders for Life-Sustaining Treatment form (MOLST) is broader, and under state law it is the only authorized form in New York for documenting a nonhospital DNR and a nonhospital Do Not Intubate order on a single document.7New York State Department of Health. Medical Orders for Life-Sustaining Treatment (MOLST) Talk to the attending practitioner about completing a MOLST instead or in addition. Both forms must be signed by a physician, nurse practitioner, or physician assistant, and both are honored by EMS.8New York State Department of Health. Policy Statement 10-05 – DNR and Medical Orders for Life-Sustaining Treatment (MOLST)
Switching Doctors or Entering a Facility
When the practitioner who issued the DNR transfers care to another physician, nurse practitioner, or physician assistant, they must inform the new practitioner about the existing order.5New York State Senate. New York Public Health Law 2994-DD – Managing a Nonhospital Order Not to Resuscitate If you change doctors on your own, raise the DNR at the first visit rather than assuming records will transfer. A nonhospital DNR can follow a patient into a hospital or nursing home during an admission, but each facility has its own protocols for documenting and continuing the order, so ask admitting staff how they will handle it.