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Homepage ➔ Fillable Do Not Resuscitate Order Form ➔ Attorney-Approved Do Not Resuscitate Order Document for the State of Arizona
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In the realm of healthcare decision-making, the Arizona Do Not Resuscitate (DNR) Order form plays a crucial role for individuals who wish to express their preferences regarding end-of-life care. This legally binding document allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest or respiratory failure. It is designed to ensure that medical professionals honor the patient’s wishes, providing peace of mind during an incredibly challenging time. The form requires specific information, including the patient’s name, date of birth, and the signatures of both the patient and a witness or healthcare provider. Importantly, it must be clearly filled out and readily accessible to ensure that healthcare personnel can respond appropriately in an emergency. Understanding the nuances of the DNR Order form is essential for patients, families, and healthcare providers alike, as it empowers individuals to make informed choices about their medical care and respect their values and beliefs. By navigating this process thoughtfully, individuals can ensure that their healthcare preferences are honored, even when they may no longer be able to voice them themselves.

Consider More Do Not Resuscitate Order Templates for Different States

What Makes a Dnr Valid - This form expresses a patient's wish not to receive CPR in case of cardiac arrest.

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Whats Dnr Mean - A DNR order aligns treatment with the patient’s preferences, focusing on quality of life rather than prolonging life.

Dos and Don'ts

When filling out the Arizona Do Not Resuscitate Order (DNR) form, it is essential to approach the process with care and attention. Below are important dos and don’ts to guide you.

  • Do ensure that you understand what a DNR order entails before completing the form.
  • Do consult with your healthcare provider to discuss your wishes and any medical implications.
  • Do clearly indicate your preferences on the form, using simple and direct language.
  • Do sign and date the form in the appropriate sections to validate it.
  • Don't fill out the form without discussing it with your family or loved ones.
  • Don't use vague language or leave sections blank, as this can lead to confusion.
  • Don't forget to keep a copy of the signed DNR order for your records and share it with your healthcare provider.
  • Don't assume that verbal instructions are sufficient; written documentation is crucial.

Arizona Do Not Resuscitate Order Sample

Arizona Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is made in accordance with Arizona state law pertaining to medical decision-making.

Patient Information:

  • Patient Name: _________________________________
  • Date of Birth: ________________________________
  • Address: ______________________________________
  • City, State, Zip: ___________________________

Physician Information:

  • Physician Name: ______________________________
  • Medical License Number: ____________________
  • Contact Number: ____________________________

Directive:

I, the undersigned, hereby declare that I do not wish to receive cardiopulmonary resuscitation (CPR) or any resuscitative measures in the event of cardiac arrest. This decision reflects my wishes regarding end-of-life care.

Signature:

_____________________________________
Date: _____________________________

Witness Information:

  • Witness Name: _______________________________
  • Witness Signature: __________________________
  • Date: _____________________________________

This document should be kept in a location that is easily accessible to medical personnel and family members. It is recommended to provide copies to your healthcare providers and keep a copy with your advance directives.

By signing this document, you affirm that you are of sound mind and understand the implications of this DNR Order.

Listed Questions and Answers

  1. What is a Do Not Resuscitate (DNR) Order in Arizona?

    A Do Not Resuscitate Order is a legal document that allows a person to refuse cardiopulmonary resuscitation (CPR) and other life-saving measures in the event of a medical emergency. In Arizona, this order is typically used by individuals with serious health conditions who wish to avoid aggressive medical interventions that may not align with their personal wishes regarding end-of-life care.

  2. Who can request a DNR Order?

    In Arizona, a DNR Order can be requested by any adult who is capable of making their own healthcare decisions. This includes individuals who are diagnosed with a terminal illness or a condition that severely limits their quality of life. Additionally, a legal guardian or an authorized healthcare decision-maker can request a DNR on behalf of someone else if that person is unable to do so.

  3. How do I obtain a DNR Order in Arizona?

    To obtain a DNR Order, you will need to fill out the Arizona Department of Health Services' official DNR form. This form can be accessed online or obtained through healthcare providers. After completing the form, it must be signed by both the patient and their physician. Once signed, it should be kept in an easily accessible location, such as with other important medical documents or with your healthcare provider.

  4. Where should I keep my DNR Order?

    It is crucial to keep your DNR Order in a location that is easily accessible to both you and your healthcare providers. Many people choose to keep it in their medical file, with their primary care physician, or in a visible place in their home. You may also consider carrying a wallet card that indicates your DNR status, which can alert emergency personnel in case of an emergency.

  5. Can I change or revoke my DNR Order?

    Yes, you can change or revoke your DNR Order at any time. If you decide to revoke it, you should inform your healthcare provider and destroy any copies of the original document. A new DNR Order can be issued if you want to make changes to your previous instructions. Always ensure that your healthcare team is aware of your current wishes.

  6. What happens if I don't have a DNR Order?

    If you do not have a DNR Order in place, medical personnel are required to perform CPR and other life-saving measures if your heart stops or if you stop breathing. This may not align with your personal wishes regarding end-of-life care. Having a DNR Order ensures that your preferences are respected during a medical emergency.

  7. Will a DNR Order affect my overall medical care?

    A DNR Order specifically pertains to resuscitation efforts and does not affect other aspects of your medical care. You will continue to receive appropriate medical treatment, including pain management and comfort care, even if you have a DNR Order in place. It is important to discuss your overall healthcare goals with your physician to ensure that your wishes are fully understood.

PDF Characteristics

Fact Name Description
Governing Law The Arizona Do Not Resuscitate Order is governed by Arizona Revised Statutes § 36-3201 to § 36-3206.
Purpose This form allows individuals to express their wish not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Eligibility Any adult who is competent may complete a Do Not Resuscitate Order in Arizona.
Signature Requirements The form must be signed by the individual or their authorized representative, and it should be witnessed by two adults or notarized.