Official Do Not Resuscitate Order Form for Arkansas

A Do Not Resuscitate (DNR) Order in Arkansas is a legal document that allows individuals to refuse resuscitation efforts in the event of cardiac arrest or respiratory failure. This form ensures that a person’s wishes regarding end-of-life care are respected and can provide peace of mind for both the individual and their loved ones. If you are considering filling out this important document, click the button below to get started.

Fill Out Do Not Resuscitate Order Here

In the realm of healthcare, making informed decisions about end-of-life care is crucial, and the Arkansas Do Not Resuscitate (DNR) Order form plays a significant role in that process. This document empowers individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. By completing this form, patients can ensure that their preferences are respected, alleviating the burden on family members and healthcare providers during critical moments. The DNR Order form must be signed by a licensed physician, indicating that the patient is fully informed about their medical condition and the implications of their decision. It is essential to understand that this form is not a one-size-fits-all solution; it should reflect personal values and medical circumstances. Additionally, the form must be readily accessible, as it needs to be presented in emergencies for it to be honored. Understanding the nuances of the Arkansas DNR Order can help individuals navigate their healthcare choices with clarity and confidence, ensuring their voices are heard when it matters most.

Document Specifics

Fact Name	Description
Definition	The Arkansas Do Not Resuscitate Order (DNR) form allows individuals to express their wish not to receive resuscitation in the event of cardiac or respiratory arrest.
Governing Law	This form is governed by the Arkansas Code Annotated § 20-13-220, which outlines the legal framework for advance directives and DNR orders in the state.
Eligibility	Any adult who is capable of making healthcare decisions can complete a DNR form. Additionally, a legal representative can do so on behalf of an incapacitated individual.
Implementation	Once signed, the DNR order must be presented to healthcare providers to ensure that the individual's wishes are honored in medical emergencies.

Key takeaways

When considering the Arkansas Do Not Resuscitate (DNR) Order form, several important points should be kept in mind to ensure clarity and compliance with state regulations.

Eligibility: The DNR order is intended for individuals with a terminal illness or who are nearing the end of life. It is crucial to assess whether the individual meets these criteria.
Completion: The form must be filled out accurately. It typically requires the signature of the patient or their legal representative, along with a physician's signature to validate the order.
Distribution: Once completed, copies of the DNR order should be distributed to all relevant parties. This includes healthcare providers, family members, and any facility where the individual may receive care.
Visibility: The DNR order should be easily accessible. It is advisable to keep a copy in a prominent location, such as on the refrigerator or with other important medical documents.
Revocation: The individual or their representative has the right to revoke the DNR order at any time. This can be done verbally or in writing, and it is essential to inform all parties involved when this occurs.
Legal Considerations: Understanding the legal implications of a DNR order is vital. It is recommended to consult with a legal professional or healthcare provider to ensure that the order aligns with the individual’s wishes and state laws.

By keeping these key takeaways in mind, individuals can navigate the process of filling out and utilizing the Arkansas Do Not Resuscitate Order form more effectively.

Arkansas Do Not Resuscitate Order Example

Arkansas Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is in accordance with the Arkansas Code Annotated, § 20-13-2201 et seq. Please fill out the information below to indicate your wishes regarding resuscitation efforts.

Patient Information:

Name: _____________________________
Date of Birth: ______________________
Address: ____________________________
Phone Number: ______________________

Physician Information:

Physician's Name: _____________________________
License Number: _______________________________
Address: ____________________________________
Phone Number: _______________________________

Patient's Wishes:

The patient hereby directs that resuscitation efforts, including but not limited to, cardiopulmonary resuscitation (CPR), mechanical ventilation, and advanced cardiac life support, shall not be initiated or continued.

Signature:

By signing below, the patient/or authorized representative confirms this Do Not Resuscitate Order.

Signature of Patient: ____________________________

Signature of Authorized Representative (if applicable): __________________________

Date: __________________________________________

Witness Information:

Witness Name: ________________________________
Witness Signature: ____________________________
Date: ______________________________________

This DNR Order is valid until revoked by the patient or by a new DNR order. A copy of this document should be kept with the patient's medical records and be accessible to emergency medical personnel.

Important Facts about Arkansas Do Not Resuscitate Order

What is a Do Not Resuscitate (DNR) Order in Arkansas?

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 Arkansas, this order is typically used by individuals with terminal illnesses or severe medical conditions who wish to avoid aggressive medical interventions that may not improve their quality of life.

Who can request a DNR Order in Arkansas?

In Arkansas, a DNR Order can be requested by a competent adult or, if the individual is unable to make decisions, by a legally authorized representative, such as a family member or a healthcare proxy. It is essential that the person requesting the DNR understands the implications of the order.

How is a DNR Order created in Arkansas?

To create a DNR Order in Arkansas, a specific form must be completed. This form typically requires the signature of the patient and the attending physician. It is crucial to ensure that all sections of the form are filled out accurately to avoid any confusion during a medical emergency.

Where should a DNR Order be kept?

The DNR Order should be kept in a location that is easily accessible, such as on the refrigerator or in a prominent place within the home. It is also advisable to inform family members, caregivers, and healthcare providers about the existence of the order so they can act accordingly in an emergency.

Does a DNR Order apply in all medical situations?

No, a DNR Order specifically applies to situations involving cardiac arrest or respiratory failure. It does not prevent other types of medical treatment or interventions. Patients can still receive necessary medical care, including pain management and comfort measures, even with a DNR in place.

Can a DNR Order be revoked?

Yes, a DNR Order can be revoked at any time by the patient or their authorized representative. To revoke the order, it is best to inform healthcare providers and remove any physical copies of the DNR form from the home. A new order can also be created if the patient's wishes change.

Is a DNR Order recognized outside of Arkansas?

While many states have similar DNR laws, the recognition of an Arkansas DNR Order in other states can vary. It is advisable to check the laws of the state where the individual may receive medical care to ensure that the order will be honored.

What should I do if I have questions about a DNR Order?

If you have questions about a DNR Order, it is important to consult with a healthcare professional or an attorney who specializes in healthcare law. They can provide guidance tailored to your specific situation and help clarify any concerns regarding the order.

Are there any costs associated with creating a DNR Order?

Generally, there are no costs associated with creating a DNR Order itself. However, there may be fees for medical consultations or legal advice if you choose to seek assistance in completing the form. Always check with your healthcare provider or legal advisor for any potential costs.

Documents used along the form

When considering end-of-life care options in Arkansas, the Do Not Resuscitate (DNR) Order form is often accompanied by several other important documents. These documents help clarify a person's healthcare wishes and ensure that their preferences are respected in various medical situations. Below is a list of commonly used forms that complement the DNR Order.

Advance Directive: This document outlines a person's preferences regarding medical treatment if they become unable to communicate their wishes. It can include instructions about life-sustaining treatments, organ donation, and other healthcare decisions.
Healthcare Power of Attorney: This form designates an individual to make healthcare decisions on behalf of someone else if they are incapacitated. It allows the appointed person to ensure that the patient's wishes are honored even when they cannot speak for themselves.
Illinois Notice to Quit: This form is a critical document in the eviction process, allowing landlords to communicate a tenant's violation of the rental agreement and demand vacating the property. For further assistance in this matter, refer to All Illinois Forms for resources and guidance.
Living Will: A living will specifies the types of medical treatment a person does or does not want in the event of a terminal illness or severe injury. It serves as a guide for healthcare providers and family members during critical moments.
Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that outlines a patient's preferences for treatments in emergency situations. Unlike an advance directive, it is designed to be actionable and is typically signed by a healthcare provider.
Patient Information and Consent Form: This form is used to gather essential information about a patient and obtain consent for various treatments. It ensures that healthcare providers have the necessary details to make informed decisions regarding the patient's care.

Understanding these documents can empower individuals to take control of their healthcare decisions. By having these forms in place, patients can ensure their wishes are respected, providing peace of mind for themselves and their loved ones during challenging times.

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Dos and Don'ts

When filling out the Arkansas Do Not Resuscitate Order form, it’s important to be careful and precise. Here are some guidelines to follow:

Do ensure that the form is completed in full.
Do sign and date the document where required.
Do keep a copy of the completed form for your records.
Do discuss your wishes with your healthcare provider.
Don't use vague language; be clear about your preferences.
Don't forget to inform family members about your decision.
Don't leave the form unsigned or undated.

Following these steps can help ensure that your wishes are respected in a medical emergency.