Valid Do Not Resuscitate Order Document Make Your Document Now

Valid Do Not Resuscitate Order Document

A Do Not Resuscitate (DNR) Order is a legal document that allows individuals to express their wishes regarding medical treatment in the event of a cardiac or respiratory arrest. This form ensures that healthcare providers honor the decision not to perform cardiopulmonary resuscitation (CPR) or other life-saving measures. Understanding the implications of a DNR Order is essential for anyone considering their end-of-life care options.

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Similar forms

  • Advance Healthcare Directive: This document allows individuals to outline their preferences for medical treatment in case they become unable to communicate. Like a DNR, it ensures that healthcare providers follow the patient’s wishes regarding life-sustaining measures.

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  • Living Will: A living will specifies the types of medical treatment a person wants or does not want in situations where they cannot express their wishes. Similar to a DNR, it provides guidance on end-of-life care decisions.

  • Durable Power of Attorney for Healthcare: This document designates someone to make medical decisions on behalf of an individual if they are incapacitated. It works alongside a DNR by ensuring that a trusted person can advocate for the patient's wishes.

  • POLST (Physician Orders for Life-Sustaining Treatment): A POLST form translates a patient’s treatment preferences into actionable medical orders. Like a DNR, it is intended for individuals with serious health conditions and ensures that their wishes are respected in emergencies.

  • Medical Orders for Scope of Treatment (MOST): Similar to POLST, this document outlines a patient’s preferences for medical treatment and interventions. It provides clear instructions to healthcare providers, ensuring that the patient's choices align with their values.

Document Sample

Do Not Resuscitate Order (DNR) Template

This Do Not Resuscitate Order (DNR) is intended to outline the patient's wishes regarding resuscitation in the event of a medical emergency. This directive is made in accordance with [State Name] state laws. Please complete the information below to tailor this document to your specific needs.

Patient Information:

  • Patient's Full Name: _________________________
  • Date of Birth: _________________________
  • Address: _________________________

Physician Information:

  • Physician's Name: _________________________
  • Contact Number: _________________________
  • Medical License Number: _________________________

Statement of Wishes:

I, the undersigned, hereby declare my wish to not receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures if I should stop breathing or if my heart should stop beating. I understand that this order will be honored by emergency medical personnel and healthcare providers in accordance with [State Name] laws.

Patient Signature: _________________________

Date: _________________________

Witness Information:

  • Witness Name: _________________________
  • Witness Signature: _________________________
  • Date: _________________________

Additional Instructions:

If there are any additional preferences or instructions regarding end-of-life care, please specify below:

____________________________________________________

____________________________________________________

This document must be kept in an accessible location and provided to healthcare providers to ensure that your wishes are respected.

Note: For any changes or revocation of this DNR Order, consult your physician and follow [State Name] regulations.

Key takeaways

Filling out a Do Not Resuscitate (DNR) Order form is an important decision that requires careful consideration. Here are some key takeaways to keep in mind:

  1. Understand the Purpose: A DNR order instructs medical personnel not to perform CPR or other resuscitative measures in the event of cardiac arrest or respiratory failure.
  2. Eligibility: Typically, a DNR order is appropriate for individuals with terminal illnesses or those who wish to avoid aggressive life-saving treatments.
  3. Consult with Healthcare Providers: Discuss your wishes with your doctor or healthcare team. They can provide guidance and help ensure that your preferences are documented correctly.
  4. Complete the Form Accurately: Fill out the DNR order form carefully. Ensure that all required information is provided, including signatures from both the patient and a witness if necessary.
  5. Communicate Your Wishes: Share copies of the completed DNR order with family members and healthcare providers. Keeping everyone informed can help avoid confusion in critical situations.

Taking these steps can help ensure that your wishes are respected and understood in times of medical crisis.

Other Templates

Instructions on How to Fill Out Do Not Resuscitate Order

Filling out a Do Not Resuscitate Order (DNR) form is an important step in ensuring that your medical preferences are respected in emergency situations. Once you have completed the form, it is crucial to share it with your healthcare provider and keep copies in accessible locations.

  1. Obtain the DNR form from your healthcare provider or download it from a reliable medical website.
  2. Read the instructions carefully to understand the requirements for completing the form.
  3. Fill in your personal information, including your full name, date of birth, and contact information.
  4. Indicate your preferences regarding resuscitation by checking the appropriate boxes or writing your wishes clearly.
  5. Consult with your healthcare provider to ensure that your choices are accurately reflected on the form.
  6. Sign and date the form to validate your decisions.
  7. Have a witness sign the form, if required by your state’s regulations.
  8. Make copies of the completed form for your medical records and for family members.
  9. Discuss your DNR order with your family and caregivers to ensure they understand your wishes.