Form of comfort care order.

The comfort care order shall: Be a distinctive form approved by the Mayor, sequentially numbered, and printed on security paper; Include a statement describing the specific medical or terminal condition of the patient and the circumstances under which the patient shall not be resuscitated; Include the name of the patient and an identification number; Include the signature of the patient, if the patient is not an incapacitated person; Be signed and dated by the attending physician of the patient; Include the attending physician’s license number and telephone number; and If the patient has an authorized decision-maker or surrogate, include the name, signature and social security number of the authorized decision-maker or surrogate. The Mayor shall provide comfort care order forms and instructions to physicians and hospitals through the Department of Health and at distribution points that the Mayor determines to be necessary to implement this chapter.