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Classification / Identification:
 Form Number:014-4519-45Edition date: 2008/01 
 Title:Do Not Resuscitate Confirmation Form
 Branch/ABC:Emergency Health Regulatory and Accountability Branch  
 Program:Emergency Health Services Land/Air  
 Purpose of Form:Used by Health Care Facility Staff and Regulated Health Care Providers  
 Ordering Information:Submit completed order request form (form # 014-0350-93) to OSSDistribution@ontario.ca (preferred option) or fax to 416-679-8192.

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