Table of Contents
The Do Not Resuscitate (DNR) Order form serves as a critical tool for individuals wishing to communicate their preferences regarding medical interventions in emergency situations. This document allows patients to specify that they do not want cardiopulmonary resuscitation (CPR) or other life-saving measures in the event of cardiac arrest or respiratory failure. It is important for the form to be completed accurately and signed by both the patient and a physician, ensuring that the individual's wishes are respected in medical settings. The DNR Order is typically recognized by healthcare providers and emergency personnel, allowing for a clear understanding of the patient's desires. Additionally, the form may include information about the patient's medical history and any relevant conditions that influenced their decision. By providing a clear directive, the DNR Order helps alleviate confusion during critical moments, allowing healthcare teams to focus on providing comfort and dignity in accordance with the patient's wishes.
Do Not Resuscitate OrderTemplates for Particular US States
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Dos and Don'ts
When filling out a Do Not Resuscitate (DNR) Order form, it is crucial to approach the process with care and consideration. Below are important guidelines to follow, as well as common pitfalls to avoid.
Things You Should Do:
- Consult with your healthcare provider to ensure you understand the implications of a DNR order.
- Clearly state your wishes regarding resuscitation and other life-sustaining treatments.
- Ensure that the form is signed by you and a witness, if required by your state.
- Keep copies of the completed form in accessible locations, such as with your medical records and with family members.
Things You Shouldn't Do:
- Do not fill out the form in haste; take the time to think through your decisions.
- Avoid using vague language that may lead to confusion about your wishes.
- Do not assume that verbal instructions are sufficient; written documentation is essential.
- Do not forget to review and update your DNR order as your health situation changes.
Do Not Resuscitate Order Sample
Do Not Resuscitate Order (DNR) - [State Name]
This Do Not Resuscitate Order (DNR) is made in accordance with the laws of [State Name]. This document is a directive regarding my health care and must be respected by all medical personnel.
Patient Information:
- Name: ____________________________
- Date of Birth: ______________________
- Address: ___________________________
- Emergency Contact: _________________
- Phone Number: _____________________
Statement of Intent:
I, the undersigned, do not wish to receive cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) in the event of cardiac or respiratory arrest.
Effective Date:
This order takes effect immediately and will remain in force until revoked in writing.
Signature:
- Patient Signature: _______________________ Date: ____________
- Witness Signature: ______________________ Date: ____________
Healthcare Provider Information:
- Provider Name: ________________________
- Provider Phone Number: _______________
- Provider Address: _____________________
This DNR Order is valid and enforceable according to the laws of [State Name]. Please attach this document to the patient’s medical records.
Listed Questions and Answers
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What is a Do Not Resuscitate Order (DNR)?
A Do Not Resuscitate Order, commonly referred to as a DNR, is a legal document that indicates a person's wishes regarding resuscitation efforts in the event of a medical emergency. Specifically, it instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) or other life-saving measures if the individual stops breathing or their heart stops beating.
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Who should consider having a DNR?
Individuals with serious or terminal illnesses, those who are elderly, or anyone who has made a personal decision to forgo aggressive life-saving treatments may consider having a DNR. It is essential for individuals to discuss their wishes with family members and healthcare providers to ensure everyone understands their preferences.
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How is a DNR created?
Creating a DNR typically involves filling out a specific form that may vary by state. This form must be signed by the individual or their legal representative and a physician. Some states also allow for electronic or online DNR forms. It is important to check local regulations to ensure compliance with state laws.
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Where should a DNR be kept?
A DNR should be easily accessible to both the individual and their healthcare providers. It is advisable to keep a copy in a visible location at home, such as on the refrigerator or with other important medical documents. Additionally, informing family members and caregivers about the location of the DNR can help ensure that it is honored in an emergency.
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Can a DNR be changed or revoked?
Yes, an individual can change or revoke a DNR at any time. If someone decides to alter their wishes, they should complete a new DNR form and ensure that all relevant parties, including healthcare providers and family members, are informed of the change. It is also important to dispose of any old forms to avoid confusion.
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What happens if a DNR is not available during a medical emergency?
If a DNR is not available when a medical emergency occurs, healthcare providers are required to perform resuscitation efforts. This can lead to unwanted interventions that may not align with the individual's wishes. Therefore, it is crucial to ensure that the DNR is readily accessible and that all parties involved are aware of its existence.
PDF Characteristics
| 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 if a person's heart stops beating or they stop breathing. |
| Legal Authority | The DNR Order is governed by state laws, which can vary. For example, in California, the relevant law is found in the California Health and Safety Code, Section 7180. |
| Eligibility | Typically, DNR Orders are appropriate for individuals with terminal illnesses, severe disabilities, or those who wish to avoid aggressive medical interventions at the end of life. |
| Signing Requirements | Most states require a DNR Order to be signed by a physician and the patient or their legal representative. Some states may have specific forms that must be used. |
| Revocation | A DNR Order can be revoked at any time by the patient or their legal representative. This can be done verbally or by destroying the document. |