Official Do Not Resuscitate Order Template for the State of Washington Make Your Document Now

Official Do Not Resuscitate Order Template for the State of Washington

A Washington Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. By completing this form, a person can ensure that their preferences for end-of-life care are respected, particularly when they are unable to communicate those wishes themselves. Understanding the importance of this form can provide peace of mind for both individuals and their loved ones.

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Similar forms

  • Living Will: A living will outlines a person's wishes regarding medical treatment in situations where they cannot communicate. Like a Do Not Resuscitate Order, it ensures that a person's preferences are respected in critical health scenarios.

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  • Healthcare Proxy: This document allows an individual to designate someone to make medical decisions on their behalf. It is similar to a DNR in that it empowers others to honor a person's healthcare wishes when they are unable to do so themselves.

  • Power of Attorney for Healthcare: A power of attorney for healthcare grants authority to another person to make medical decisions. It complements a DNR by providing a trusted individual the ability to interpret and implement a person's healthcare preferences.

  • Physician Orders for Life-Sustaining Treatment (POLST): POLST forms detail specific medical treatments a person wants or does not want. Similar to a DNR, it is a medical order that guides healthcare providers in emergencies.

  • Advance Directive: An advance directive encompasses various documents that communicate a person's healthcare preferences. It includes a DNR and ensures that an individual's wishes regarding end-of-life care are clearly stated and respected.

Document Sample

Washington Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is established in accordance with Washington State laws regarding medical treatment and resuscitation. It is designed for individuals who wish to decline resuscitation efforts in case of a medical emergency.

By completing this form, I acknowledge that I understand its purpose and the implications of my choices regarding my medical treatment.

Patient Information:

  • Full Name: ________________________________
  • Date of Birth: ________________________________
  • Address: ________________________________

Healthcare Decision-Maker (if applicable):

  • Name: ________________________________
  • Relationship to Patient: ________________________________
  • Contact Number: ________________________________

DNR Order Confirmation:

I hereby declare that I do not wish to receive resuscitation attempts, including but not limited to CPR or advanced cardiac life support. This order shall remain in effect until revoked.

Signature: ________________________________

Date: ________________________________

Witness Information:

  • Name: ________________________________
  • Signature: ________________________________
  • Date: ________________________________

Please note: It is recommended that this form be discussed with your healthcare provider and included in your medical records. Always carry a copy with you in case of an emergency.

Download Do Not Resuscitate Order PDF

Key takeaways

Here are some key takeaways about filling out and using the Washington Do Not Resuscitate Order form:

  1. The form is designed for individuals who wish to avoid resuscitation in case of a medical emergency.
  2. It is important to discuss your wishes with your healthcare provider before completing the form.
  3. The form must be signed by both the patient and a healthcare provider to be valid.
  4. Ensure that the form is filled out completely and accurately to avoid confusion in an emergency.
  5. Keep a copy of the completed form in a visible place, such as on the refrigerator or with other important documents.
  6. Provide copies of the form to family members, caregivers, and your healthcare provider.
  7. The form can be revoked at any time by the patient, but this should be done in writing.
  8. Review the form regularly to ensure it still reflects your wishes, especially if your health status changes.
  9. Understand that the Do Not Resuscitate Order only applies to resuscitation efforts and does not affect other medical treatments.
  10. Be aware that emergency medical personnel are trained to recognize and follow the Do Not Resuscitate Order in emergencies.

Other Common State-specific Do Not Resuscitate Order Templates

Dnr Directive - Can be a part of broader advance care planning discussions with healthcare teams.

Dnr Form North Carolina - The DNR order should ideally be reviewed periodically to align with any changes in a patient's health status or wishes.

For those looking to navigate the process of applying for public housing in New York City, the New York City Housing Application form serves as an essential resource. It not only provides a comprehensive overview of eligibility criteria, including income limits and family definitions, but it also ensures that applicants understand the importance of not paying any fees throughout the application process. To assist applicants further, resources such as https://nyforms.com/nyc-housing-application-template/ can offer valuable insights into filling out the application correctly.

How Old Do You Have to Be to Get a Dnr - Reflects personal values and wishes regarding the approach to dying.

Whats Dnr - A DNR can be part of a larger conversation about quality of life and personal values regarding medical treatment.

Instructions on How to Fill Out Washington Do Not Resuscitate Order

Completing the Washington Do Not Resuscitate Order form is an important step for individuals who wish to communicate their healthcare preferences. This process requires careful attention to detail to ensure that the form accurately reflects your wishes. Follow these steps to fill out the form correctly.

  1. Obtain a copy of the Washington Do Not Resuscitate Order form. This can be downloaded from the Washington State Department of Health website or requested from your healthcare provider.
  2. Begin by filling in your full name in the designated section at the top of the form.
  3. Provide your date of birth. This information helps to confirm your identity.
  4. Indicate your address, including street, city, state, and zip code. This ensures that your healthcare providers can locate you easily.
  5. Sign the form in the appropriate area. Your signature indicates that you understand and agree with the content of the document.
  6. Have a witness sign the form. The witness must be an adult who is not related to you and is not your healthcare provider.
  7. Make sure to date the witness's signature. This confirms when the document was signed.
  8. Keep a copy of the completed form for your records. It’s also advisable to share copies with your healthcare provider and family members.