Printable Do Not Resuscitate Order Form

A Do Not Resuscitate Order (DNR) is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form ensures that healthcare providers respect a person's decision not to undergo life-saving measures, focusing instead on comfort and quality of life. Understanding and completing this form is essential for those who wish to make their healthcare preferences known.

To take the next step in ensuring your wishes are honored, please fill out the form by clicking the button below.

Fill Out Do Not Resuscitate Order Here

A Do Not Resuscitate (DNR) Order form is an important legal document that allows individuals to express their wishes regarding medical treatment in the event of a cardiac arrest or respiratory failure. This form serves as a directive for healthcare providers, indicating that the individual does not want to receive cardiopulmonary resuscitation (CPR) or other life-saving measures. It typically requires the signature of the patient, or a legally authorized representative, and may need to be witnessed or notarized, depending on state regulations. The DNR Order form also often includes sections that outline the individual's medical condition, the reasons for the request, and any additional preferences regarding end-of-life care. Understanding the implications of this document is crucial, as it can significantly impact the type of medical interventions a person receives during critical moments. By clearly articulating one's wishes, individuals can ensure that their healthcare aligns with their values and desires, providing peace of mind for both themselves and their loved ones.

State-specific Guides for Do Not Resuscitate Order Forms

Document Specifics

Fact Name	Description
Definition	A Do Not Resuscitate (DNR) Order is a legal document that indicates a person's wish not to receive CPR or other resuscitative measures in the event of cardiac arrest.
Legal Status	DNR Orders are recognized in all 50 states, but the specific laws and requirements for their validity can vary by state.
State-Specific Forms	Many states require specific forms to be completed for a DNR Order to be valid. Check your state's health department for the correct form.
Governing Laws	In California, for example, the DNR Order is governed by the California Health and Safety Code, Section 7180.
Patient Autonomy	A DNR Order supports patient autonomy, allowing individuals to make decisions about their own medical care.
Healthcare Provider Responsibilities	Healthcare providers are required to respect a valid DNR Order and not perform resuscitation if it is in place.
Emergency Situations	In emergency situations, emergency medical personnel must be aware of the DNR Order to ensure compliance with the patient's wishes.
Revocation	A DNR Order can be revoked at any time by the patient or their legal representative, and it should be documented appropriately.
Communication	It is crucial to communicate the existence of a DNR Order to family members and healthcare providers to avoid confusion during emergencies.
Legal Advice	Individuals should consider seeking legal advice when creating a DNR Order to ensure it meets state-specific requirements.

Key takeaways

Filling out a Do Not Resuscitate (DNR) Order form is an important step in making your healthcare wishes known. Here are some key takeaways to consider:

Understand the Purpose: A DNR order communicates your desire not to receive cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest.
Consult with Healthcare Providers: It is essential to discuss your wishes with your doctor or healthcare team. They can provide guidance and help ensure your choices align with your medical needs.
Be Clear and Specific: When filling out the form, make sure your preferences are clearly stated. Ambiguities can lead to confusion during critical moments.
Involve Family Members: Engaging family members in the conversation can help ensure everyone understands your wishes and can support your decisions.
Keep Copies Accessible: Once completed, keep copies of the DNR order in easily accessible places. Share them with your healthcare providers and family members.
Review Regularly: Your health status and preferences may change over time. Regularly review and update your DNR order as needed.
Legal Validity: Ensure that the DNR order complies with your state’s laws to guarantee that it is legally recognized and respected by healthcare professionals.

Being proactive about your healthcare decisions can provide peace of mind for you and your loved ones. It is a way to ensure that your values and preferences are honored during critical times.

Do Not Resuscitate Order Example

Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is designed in accordance with the laws of [State Name]. It expresses your wishes regarding medical treatment in the event of a life-threatening medical emergency. Please complete this document carefully.

Patient Information

Full Name: _____________________________
Date of Birth: _________________________
Address: ________________________________
City, State, Zip: ______________________
Phone Number: _________________________

Physician Information

Physician's Name: ______________________
Physician's Contact Number: ____________

Statement of Wishes

I, the above-named patient, hereby request that in the event of a cardiac or respiratory arrest, no resuscitative efforts be made to prolong my life.

Signature

My signature below acknowledges that I understand this order and that I have discussed it with my physician.

Patient's Signature: ____________________
Date: _________________________________

Witness Information

It is recommended that this document be signed by two witnesses. Witnesses should not be related to the patient or entitled to any portion of the patient's estate.

Witness 1 Name: ______________________
Witness 1 Signature: _________________
Date: _________________________________
Witness 2 Name: ______________________
Witness 2 Signature: _________________
Date: _________________________________

Storage and Distribution

Please keep this document in your medical records and provide copies to your family and healthcare providers. It is essential that your wishes are clear to all involved in your care.

Important Facts about Do Not Resuscitate Order

What is a Do Not Resuscitate (DNR) Order?

A Do Not Resuscitate Order is a legal document that allows a person to refuse certain medical treatments, specifically cardiopulmonary resuscitation (CPR), in the event of a medical emergency. It is often used by individuals with serious health conditions who wish to avoid aggressive life-saving measures that may not align with their wishes for end-of-life care.

Who can request a DNR Order?

Typically, a DNR Order can be requested by a patient who is of sound mind and able to make their own medical decisions. In some cases, family members or legal guardians may be able to request a DNR on behalf of someone who is unable to do so. It's important that the patient’s wishes are clearly understood and documented.

How is a DNR Order created?

A DNR Order is usually created in consultation with a healthcare provider. The patient must discuss their wishes regarding resuscitation with their doctor, who can help complete the necessary forms. The order must be signed by the patient (or their representative) and the physician to be valid. It is also advisable to keep copies of the order in easily accessible locations, such as with medical records or at home.

Will a DNR Order affect other medical treatments?

No, a DNR Order specifically addresses only resuscitation efforts. It does not prevent a person from receiving other types of medical care, such as medications, pain relief, or comfort measures. Patients can still receive all other necessary treatments to manage their health conditions.

Can a DNR Order be changed or revoked?

Yes, a DNR Order can be changed or revoked at any time as long as the patient is able to communicate their wishes. If a patient decides to change their mind, they should inform their healthcare provider and ensure that a new order is documented. It is crucial to keep all medical staff informed about any changes to ensure that the patient's current wishes are respected.

Documents used along the form

A Do Not Resuscitate (DNR) Order is an important document that outlines a person's wishes regarding resuscitation efforts in the event of a medical emergency. Along with the DNR Order, several other forms and documents may be used to ensure that a person's healthcare preferences are respected. Below is a list of common documents associated with a DNR Order.

Advance Directive: This document provides guidance on a person's healthcare preferences in situations where they cannot communicate their wishes. It may include instructions about medical treatments and appoint a healthcare proxy.
Living Will: A living will specifies what types of medical treatment a person wants or does not want in the event of a terminal illness or severe injury. It focuses on end-of-life care decisions.
Healthcare Power of Attorney: This legal document allows a person to designate someone to make healthcare decisions on their behalf if they become unable to do so. It can work in conjunction with a DNR Order.
Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that outlines a patient's preferences for life-sustaining treatments. It is often used for individuals with serious illnesses and complements a DNR Order.
Patient Advocate Designation: This document allows a person to appoint an advocate to ensure their healthcare wishes are followed. It can be especially useful in complex medical situations.
Do Not Intubate (DNI) Order: A DNI Order indicates that a person does not wish to be intubated or placed on a ventilator. This document can be used alongside a DNR Order to clarify specific wishes.
Emergency Medical Services (EMS) DNR Form: This form is specifically designed for use by emergency medical personnel. It communicates a person's DNR wishes in emergency situations outside of a hospital setting.
Georgia SOP Form: This form is crucial for navigating visitation within Georgia's correctional facilities, streamlining the process for inmates and their families. For more information, visit https://georgiapdf.com/georgia-sop.
Medical Records: Keeping updated medical records is essential. They provide healthcare providers with important information about a person's medical history and preferences, including any DNR Orders or advance directives.

Understanding these documents can help individuals make informed decisions about their healthcare preferences. It is advisable to discuss these forms with family members and healthcare providers to ensure that everyone is aware of and respects a person's wishes.

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Dos and Don'ts

When filling out a Do Not Resuscitate Order (DNR) form, it's important to approach the process with care. Here are five things to keep in mind:

Do: Clearly state your wishes regarding resuscitation. Be specific about what you want.
Do: Discuss your decision with your healthcare provider. They can provide guidance and answer questions.
Do: Ensure that the form is signed by you and a witness, if required. Proper signatures are crucial for validity.
Do: Keep copies of the completed form in accessible locations. Share it with family members and healthcare professionals.
Do: Review and update the form as needed. Your wishes may change over time.

Don't: Rush through the process. Take your time to understand the implications of your decision.
Don't: Leave any sections of the form blank. Incomplete forms may not be honored.
Don't: Assume that verbal instructions are enough. A written order is necessary for clarity.
Don't: Forget to inform your healthcare team about the DNR order. Communication is key.
Don't: Ignore the emotional aspects of this decision. Seek support if needed.