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Homepage ➙ Attorney-Approved Do Not Resuscitate Order Document
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The Do Not Resuscitate Order (DNR) form is an important legal document that allows individuals to express their wishes regarding medical treatment in the event of a life-threatening situation. This form is particularly relevant for those who may be facing terminal illnesses or severe health conditions, as it provides clarity to healthcare providers about the patient's preferences concerning resuscitation efforts. When completed, the DNR form typically includes essential details such as the patient's name, date of birth, and the specific medical circumstances under which resuscitation should not be performed. Additionally, it often requires the signatures of the patient, or their legal representative, as well as a physician to validate the order. Understanding the implications of a DNR is crucial, as it not only guides medical personnel but also serves to alleviate the emotional burden on family members during critical moments. By having a DNR in place, individuals can ensure that their healthcare aligns with their values and wishes, fostering a sense of control over their medical decisions at a time when they may be unable to voice them themselves.

How to Write Do Not Resuscitate Order

Filling out a Do Not Resuscitate (DNR) Order form is an important step in expressing your healthcare preferences. This document outlines your wishes regarding resuscitation efforts in the event of a medical emergency. It is essential to ensure that all information is completed accurately to avoid any confusion during critical moments.

  1. Obtain a blank Do Not Resuscitate Order form from your healthcare provider or a trusted online source.
  2. Begin by filling in your full name, date of birth, and any other identifying information requested on the form.
  3. Provide the name and contact information of your primary healthcare provider.
  4. Clearly indicate your decision regarding resuscitation by checking the appropriate box or signing where indicated.
  5. Include any additional instructions or preferences regarding your healthcare, if the form allows for such details.
  6. Sign and date the form to validate your wishes.
  7. Have a witness sign the form if required, ensuring they are not a family member or someone who may benefit from your decisions.
  8. Make copies of the completed form for your records and distribute copies to your healthcare provider and family members.

State-specific Do Not Resuscitate Order Documents

Misconceptions

Understanding a Do Not Resuscitate (DNR) order is crucial for patients and their families. Several misconceptions can lead to confusion about its purpose and implications. Here are five common misconceptions:

  • A DNR order means I will not receive any medical treatment. This is not true. A DNR order specifically addresses resuscitation efforts in the event of cardiac arrest. Patients can still receive other forms of medical care, including pain management and comfort measures.
  • A DNR order is only for terminally ill patients. While many people associate DNR orders with end-of-life care, they can be appropriate for anyone who wishes to avoid resuscitation in certain medical situations, regardless of their overall health status.
  • This misconception is false. DNR orders can be established in various settings, including at home or in long-term care facilities, as long as the proper documentation is in place.
  • Generally, a DNR order is a legal document that reflects the patient’s wishes. Family members cannot simply override it unless they have legal authority, such as being a designated healthcare proxy.
  • This is incorrect. Patients can change or revoke their DNR orders at any time, provided they are mentally competent to make such decisions. It is important to communicate any changes to healthcare providers.

By addressing these misconceptions, individuals can make more informed decisions regarding their healthcare preferences.

Do Not Resuscitate Order Example

Do Not Resuscitate Order Template - State of [Your State]

This Do Not Resuscitate (DNR) Order is made in accordance with the laws of the State of [Your State]. It reflects the wishes of the individual named below regarding medical treatment in the event of a cardiac or respiratory arrest.

Patient Information:

  • Patient's Full Name: _________________________________
  • Date of Birth: _________________________________
  • Address: ______________________________________
  • Phone Number: _________________________________

Healthcare Representative (if applicable):

  • Name: __________________________________________
  • Relationship to Patient: ________________________
  • Contact Number: ______________________________

Order Statement:

I, the undersigned, hereby declare that if my heart stops beating or I stop breathing, I do not wish to receive the following life-sustaining treatments:

  • Cardiopulmonary resuscitation (CPR)
  • Advanced cardiac life support
  • Artificial ventilation
  • Defibrillation

This decision has been made voluntarily and reflects my current health care wishes. It is valid until revoked by me in writing.

Signature: ____________________________________

Date: ________________________________________

Witness Information:

  • Name: __________________________________________
  • Signature: _____________________________________
  • Date: ________________________________________

This document should be reviewed periodically and may need to be updated based on changes in health status or personal wishes.

Key takeaways

When filling out and using a Do Not Resuscitate (DNR) Order form, consider the following key takeaways:

  • Understand the purpose of the DNR Order. It indicates a person's wish not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
  • Ensure that the form is completed accurately. Mistakes can lead to confusion and unwanted medical interventions.
  • Consult with healthcare providers. Discussing your wishes with medical professionals can provide clarity and ensure that your preferences are understood.
  • Include personal information. The DNR Order should have the patient's full name, date of birth, and other identifying details.
  • Sign and date the form. A valid DNR Order requires the patient's signature, or that of a legal representative, along with the date of signing.
  • Keep the form accessible. Place copies in easily reachable locations, such as with medical records or on the refrigerator.
  • Inform family members and caregivers. Make sure that everyone involved in the patient's care is aware of the DNR Order.
  • Review the DNR Order regularly. Changes in health status or personal preferences may necessitate updates to the form.
  • Understand state laws. DNR regulations can vary by state, so familiarize yourself with local requirements.
  • Consider additional advance directives. A DNR Order can be part of a broader plan that includes other medical treatment preferences.

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Dos and Don'ts

When filling out a Do Not Resuscitate (DNR) Order form, careful consideration is essential. This document can significantly impact medical care and decisions in critical situations. Here are some guidelines to follow and avoid:

  • Do consult with a healthcare professional before completing the form to ensure you understand its implications.
  • Do discuss your wishes with family members or loved ones to ensure they are aware of your decisions.
  • Do clearly state your preferences in the form, using straightforward language to avoid any ambiguity.
  • Do keep a copy of the signed DNR Order in a visible location, such as with your medical records or on your refrigerator.
  • Don't sign the form without fully understanding the consequences of a DNR order.
  • Don't assume that medical staff will automatically know your wishes; always communicate your decisions clearly.
  • Don't forget to review and update the DNR Order periodically, especially after significant changes in your health status.

Similar forms

A Living Will is a document that outlines an individual's preferences regarding medical treatment in situations where they are unable to communicate their wishes. Like a Do Not Resuscitate (DNR) Order, it focuses on end-of-life care. Both documents ensure that a person's healthcare choices are respected, especially concerning life-sustaining treatments. While a DNR specifically addresses resuscitation efforts, a Living Will can cover a broader range of medical interventions, such as artificial nutrition and hydration.

A Healthcare Power of Attorney grants someone the authority to make medical decisions on behalf of another person if they become incapacitated. Similar to a DNR Order, this document emphasizes the importance of patient autonomy. It allows individuals to appoint a trusted person to make choices aligned with their values and preferences. While a DNR specifies actions to avoid, a Healthcare Power of Attorney empowers someone to make decisions, including the acceptance or refusal of resuscitation efforts.

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An Advance Directive combines elements of both a Living Will and a Healthcare Power of Attorney. It provides instructions for medical treatment preferences and designates an individual to make decisions if the patient cannot do so. This document shares similarities with a DNR Order by ensuring that a person's wishes regarding resuscitation and other medical interventions are clearly articulated and respected. It serves as a comprehensive guide for healthcare providers and family members in critical situations.

A Physician Orders for Life-Sustaining Treatment (POLST) form is designed for individuals with serious illnesses. It translates a patient’s wishes into actionable medical orders. Like a DNR Order, it addresses resuscitation efforts but is more comprehensive, covering various treatments such as intubation and artificial nutrition. Both documents aim to communicate a patient's preferences to healthcare providers, ensuring that their choices are honored during emergencies.

An Organ Donation Consent form allows individuals to express their wishes regarding organ donation after death. While this document is focused on posthumous decisions, it shares a common goal with a DNR Order: to ensure that a person's wishes are respected. Both documents require clear communication about preferences, and they play a crucial role in end-of-life planning. By completing these forms, individuals can ensure that their desires regarding medical interventions and organ donation are honored by healthcare professionals.