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TATE (DNR) ORDER FORM Patient Directive I, , born on , hereby direct the following in the event of: (print full name) (birth date) 1. FULL CARDIOPULMONARY ARREST (When both breathing and heartbeat stop): x Do Not Attempt Cardiopulmonary Resuscitation (CPR) (Measures to promote patient comfort and dignity will be provided.) 2. PRE-ARREST EMERGENCY (When breathing is labored or stopped, and heart is still beating): SELECT ONE Do Attempt Cardiop.

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