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California DNR-Registry Medallion

$70.00

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Description

Order a DNR medallion that lets all know you want NO attempt to resuscitate your heart and lungs but that you DO want to receive other treatment to keep you alive.

Before you can order a medallion, you must obtain and complete a State of California EMSA approved form that YOU (or YOUR DESIGNATED AGENT) and YOUR PHYSICIAN must sign and return to Caring Advocates: Send your form to Caring Advocates; 2240 Encinitas Blvd. Ste. D, #334, Encinitas, CA 92024-4345 or FAX it to 888 767 6322 or scan it and attach it to an email: medallions@caringadvocates.org

You can obtain one of the two forms that you (or your surrogate) and your physician must sign from:
1. A valid original "Statewide Emergency Medical Services Authority (EMSA)/California Medical Association (CMA) Prehospital DNR Form" which can be downloaded from www.emsa.ca.gov/Media/Default/PDF/DNRForm.pdf
Or;
2. A valid original "EMSA approved Physician Orders for Life Sustaining Treatment (POLST) Form," about which more information is available at the web site http://capolst.org/. POLST Forms can be downloaded/completed from www.emsa.ca.gov//Media/Default/PDF/Final-2014-ENG-CA-POLST-Form-1.pdf

Caring Advocates will not engrave an ID without the following items:

1) DNR/POLST/MOLST/COLST Policy
A signed copy of your DNR/POLST/MOLST/COLST form. This form will be kept on file and available if and when needed 24/7. Send your form to Caring Advocates; 2240 Encinitas Blvd. Ste. D, #334, Encinitas, CA 92024-4345 or FAX it to 888 767 6322 or scan it and attach it to an email: medallions@caringadvocates.org.

2) A completed Medallion Order form: CLICK HERE to complete your DNR Registry Medallion Order Form (.pdf) to print and mail OR email.

NOTE: For payment made by check, please make payable to Institute for Strategic Change. (California residents must add 7.75% sales tax.)