Official Do Not Resuscitate Order Template
A Do Not Resuscitate Order (DNR) form is a crucial document that allows individuals to express their wishes regarding medical treatment in the event of a life-threatening situation. This form is particularly significant for those with serious health conditions or for individuals who wish to avoid aggressive medical interventions that may not align with their personal values or quality of life considerations. It typically includes essential information such as the patient's name, date of birth, and a clear statement indicating the desire not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures in the event of cardiac arrest or respiratory failure. The DNR form must be signed by the patient or their legal representative, along with a physician's signature, to ensure that it is legally valid and respected by medical personnel. Understanding the implications of this order is vital, as it directly impacts the care a patient will receive during critical moments. By discussing preferences with family members and healthcare providers, individuals can ensure that their wishes are honored and that they receive care that reflects their values and desires.
Similar forms
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Living Will: A living will is a legal document that outlines a person's preferences regarding medical treatment in situations where they are unable to communicate their wishes. Like a Do Not Resuscitate Order, it provides clear guidance to healthcare providers about the individual's desires for end-of-life care.
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Healthcare Proxy: This document allows an individual to designate someone else to make medical decisions on their behalf if they become incapacitated. Similar to a DNR, it ensures that a person's healthcare choices are honored, especially in critical situations.
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Power of Attorney for Healthcare: This legal instrument grants authority to an agent to make healthcare decisions for another person. Like a DNR, it is a tool for ensuring that medical care aligns with the individual’s wishes, particularly when they cannot express those wishes themselves.
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Advance Directive: An advance directive encompasses both living wills and healthcare proxies. It serves as a comprehensive document that provides instructions about medical care preferences and appoints someone to make decisions, much like a DNR focuses specifically on resuscitation wishes.
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Physician Orders for Life-Sustaining Treatment (POLST): A POLST form translates a patient's preferences into actionable medical orders. Similar to a DNR, it is designed for individuals with serious illnesses, ensuring that their treatment preferences, including resuscitation wishes, are clearly communicated and respected.
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Do Not Intubate Order: This document specifically instructs healthcare providers not to use intubation to assist with breathing. Like a DNR, it reflects a patient's wishes regarding life-sustaining measures, particularly in emergency situations where resuscitation methods may be considered.
Do Not Resuscitate Order - Tailored for State
Guidelines on Writing Do Not Resuscitate Order
Filling out a Do Not Resuscitate (DNR) Order form is an important step in ensuring your healthcare wishes are respected. This document allows you to communicate your preferences regarding medical interventions in emergency situations. It’s crucial to approach this process thoughtfully, as it involves significant personal decisions about your health care.
- Begin by obtaining the DNR Order form. You can usually find this at your healthcare provider's office or on their website.
- Read through the form carefully. Familiarize yourself with each section to understand what information is required.
- Fill in your personal information. This typically includes your full name, date of birth, and contact information.
- Designate a healthcare representative, if desired. This person will be responsible for ensuring that your wishes are followed.
- Clearly state your wishes regarding resuscitation. There may be options to indicate your preferences for CPR and other life-saving measures.
- Sign and date the form. Your signature is necessary to validate your choices.
- Have a witness sign the form. Most states require that a witness, who is not related to you or your healthcare provider, signs to confirm your decision.
- Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and any family members involved in your care.
Once you have filled out the DNR Order form, ensure that it is stored in an accessible place. Inform your healthcare providers and loved ones about your decision. This will help ensure that your wishes are honored in any medical situation that may arise.
File Information
| Fact Name | Description |
|---|---|
| Definition | A Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform CPR or other life-saving measures in the event of cardiac arrest. |
| Legal Standing | In the United States, DNR Orders are recognized in all states, but specific regulations and forms may vary by state. |
| Governing Laws | Each state has its own laws governing DNR Orders. For example, California's DNR Orders are governed by the California Health and Safety Code, while New York follows Public Health Law § 2994-d. |
| Eligibility | Typically, DNR Orders are intended for individuals with terminal illnesses or those who wish to avoid aggressive medical interventions at the end of life. |
| Signing Requirements | Most states require the DNR Order to be signed by a physician and the patient or their legal representative to be valid. |
| Revocation | A DNR Order can be revoked at any time by the patient or their authorized representative, and the revocation should be documented appropriately. |
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