Halachic Health Care Proxy Form (Agudah version) - This form designates a representative to make medical decisions on the patient's behalf, should he/she become incapacitated. As always, consult your rabbi for guidance.

POLST FormThis form specifies the level of care that the patient wishes to receive pre-hospitally, should he/she become incapacitated. This is very specific regarding certain types of pre-hospital interventions. This form should be readily available. As always, consult your Rabbi for guidance.  

Halachic Health Care Proxy Form (RCA version) - This form designates a representative to make medical decisions on the patient's behalf, should he/she become incapacitated. As always, consult your rabbi for guidance.

Medical Questionnaire Form - This form should be filled out in advance for any chronically-ill patient. In the event that Hatzolah is called, this should be presented to the crew to provide them with the necessary information for the patient. This form should be readily available.

DNR (Do Not Resuscitate Form - This form states that in the event of cardiac or respiratory arrest, resuscitative efforts like CPR should be withheld.  This form does not provide direction for pre-hospital care as long as the patient is breathing and has a pulse. This form should be readily available. As always, consult your rabbi for guidance.


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