Official  Do Not Resuscitate Order Form for Nebraska

Official Do Not Resuscitate Order Form for Nebraska

A Nebraska 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. This form serves as a vital tool for ensuring that a person's preferences are respected when they are unable to communicate them. Understanding and completing this form can provide peace of mind for both individuals and their families during challenging times.

Take the important step of filling out the Nebraska DNR form by clicking the button below.

Fill Out Do Not Resuscitate Order Here

The Nebraska Do Not Resuscitate Order (DNR) form serves as a critical document for individuals who wish to communicate their preferences regarding resuscitation efforts in the event of a medical emergency. This form allows patients to express their desire to forgo life-saving measures such as CPR or advanced cardiac life support. It is essential for ensuring that healthcare providers honor the patient’s wishes, particularly in situations where the patient is unable to communicate. The DNR form must be completed and signed by a qualified healthcare provider, and it requires the patient's signature or that of a legal representative. Additionally, it is advisable for individuals to discuss their choices with family members and healthcare professionals to ensure clarity and understanding. By having a DNR order in place, patients can take control of their end-of-life care and ensure that their preferences are respected in critical moments.

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 cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Governing Law The Nebraska Do Not Resuscitate Order is governed by the Nebraska Revised Statutes, specifically Sections 71-4810 to 71-4816.
Eligibility Any adult who is capable of making informed medical decisions can complete a DNR order.
Signature Requirement The DNR order must be signed by the patient, or by a legal representative if the patient is unable to sign.
Healthcare Provider's Role Healthcare providers must honor a valid DNR order as part of their legal and ethical obligations.
Notification It is essential to inform all healthcare providers involved in the patient’s care about the existence of a DNR order.
Revocation A DNR order can be revoked at any time by the patient or their representative, verbally or in writing.
Form Accessibility The Nebraska DNR order form is available through healthcare providers and online resources, ensuring easy access for those who need it.

Key takeaways

The Nebraska Do Not Resuscitate (DNR) Order form is a crucial document for individuals who wish to express their preferences regarding resuscitation efforts in case of a medical emergency. Here are some key takeaways regarding its use and completion:

  • The form must be completed by the patient or their legally authorized representative.
  • It is essential to ensure that the form is signed and dated to be considered valid.
  • The DNR Order should be prominently displayed in the patient's medical records and at home for easy access by emergency personnel.
  • Patients can revoke the DNR Order at any time, and this revocation should also be documented.
  • Healthcare providers are required to honor the DNR Order as long as it is properly completed and valid.
  • It is advisable to discuss the DNR Order with family members and healthcare providers to ensure everyone understands the patient's wishes.
  • While the DNR Order specifically addresses resuscitation efforts, it does not affect other medical treatments or care options.

Nebraska Do Not Resuscitate Order Example

Nebraska Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is executed according to Nebraska Statute 71-4810. It allows you to express your wishes regarding resuscitation efforts in the event of a medical emergency.

Patient Information:

  • Patient Name: ____________________________
  • Patient Date of Birth: _____________________
  • Patient Address: __________________________
  • Patient Phone Number: _____________________

Medical Condition and Wishes:

If I am unable to make my medical decisions and experience a medical emergency, I do not wish to receive resuscitative measures. This includes, but is not limited to, cardiopulmonary resuscitation (CPR) and advanced cardiac life support (ACLS).

The following individuals are authorized to present this DNR Order to medical personnel:

  • Authorized Individual 1 Name: ____________________________
  • Authorized Individual 1 Phone Number: _____________________
  • Authorized Individual 2 Name: ____________________________
  • Authorized Individual 2 Phone Number: _____________________

Signature and Acknowledgment:

I, the undersigned patient, confirm that I understand my rights regarding this DNR Order and that I voluntarily choose to have a DNR in place according to my wishes.

Patient Signature: ________________________

Date: ________________________

Witnessed by:

Witness Name: ________________________

Witness Signature: ________________________

Date: ________________________

Important Facts about Nebraska Do Not Resuscitate Order

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

A Do Not Resuscitate Order is a legal document that allows a person to refuse resuscitation efforts in the event of a medical emergency. In Nebraska, this order is particularly important for individuals who wish to avoid life-saving measures like CPR or intubation when they are near the end of life or have a terminal condition.

Who can request a DNR Order?

In Nebraska, a DNR Order can be requested by the individual themselves if they are of sound mind. Additionally, a legal guardian or an authorized healthcare decision-maker can also request a DNR on behalf of someone who is unable to make their own medical decisions.

How do I obtain a DNR Order form?

You can obtain a DNR Order form from various sources, including hospitals, healthcare providers, or the Nebraska Department of Health and Human Services website. It's important to ensure that you are using the most current version of the form.

What information is required on the DNR Order form?

The DNR Order form typically requires personal information such as the patient's name, date of birth, and signature. It also needs to be signed by a physician who confirms that the patient understands the implications of the order.

Is a DNR Order valid in all healthcare settings?

Yes, a properly completed and signed DNR Order is valid in all healthcare settings in Nebraska, including hospitals, nursing homes, and at home. However, it's crucial to ensure that the order is readily available to healthcare providers when needed.

Can a DNR Order be revoked?

Yes, a DNR Order can be revoked at any time. The individual who signed the order can simply inform their healthcare provider, or they can destroy the document to indicate that they no longer wish to have the DNR in place.

What if I change my mind about my DNR Order?

If you change your mind, you can revoke the DNR Order as mentioned earlier. It's essential to communicate your decision to your healthcare team and ensure that they have the most up-to-date information about your wishes.

Do I need a lawyer to create a DNR Order?

No, you do not need a lawyer to create a DNR Order in Nebraska. However, it may be helpful to discuss your wishes with a healthcare professional or a trusted family member to ensure that your intentions are clear.

Will my DNR Order be honored if I travel outside of Nebraska?

While most states recognize DNR Orders, laws can vary. It's wise to check the specific regulations of the state you are visiting. Carrying a copy of your DNR Order and any relevant medical information can help ensure your wishes are respected while traveling.

How can I ensure my DNR Order is known and respected?

To ensure your DNR Order is known, discuss it with your family, friends, and healthcare providers. Consider wearing a medical alert bracelet that indicates your DNR status. Keeping copies of the order in accessible places can also help ensure that your wishes are respected in an emergency.

Documents used along the form

When considering end-of-life care options, individuals and families often encounter various forms and documents that work in tandem with the Nebraska Do Not Resuscitate Order (DNR) form. Understanding these documents can help ensure that your wishes are respected and that you receive the appropriate care. Below are four important forms that are commonly used alongside the DNR form.

  • Advance Directive: This document outlines your preferences for medical treatment in situations where you may be unable to communicate your wishes. It allows you to specify the types of care you do or do not want, including life-sustaining treatments.
  • Health Care Power of Attorney: This legal form designates a trusted individual to make medical decisions on your behalf if you become incapacitated. It ensures that someone who knows your values and preferences can advocate for you in critical situations.
  • Living Will: A living will is a specific type of advance directive that details your wishes regarding medical treatment at the end of life. It typically addresses preferences around life support and other interventions, providing clear guidance to healthcare providers and loved ones.
  • Articles of Incorporation: To formally establish your corporation, refer to the necessary Articles of Incorporation documentation required by the state.
  • Physician Orders for Life-Sustaining Treatment (POLST): This form translates your treatment preferences into actionable medical orders. It is designed for individuals with serious illnesses and complements the DNR by specifying what types of medical interventions you want or do not want.

Understanding these documents can empower you and your loved ones to make informed decisions about healthcare preferences. By having these forms in place, you can ensure that your wishes are honored, providing peace of mind during difficult times.

Consider More Do Not Resuscitate Order Forms for US States

Dos and Don'ts

Filling out a Do Not Resuscitate (DNR) Order form in Nebraska is an important step for individuals who wish to communicate their healthcare preferences. Here’s a list of things to keep in mind while completing this form.

  • Do discuss your wishes with your healthcare provider. This ensures that you understand the implications of a DNR order.
  • Do involve your family in the conversation. Keeping loved ones informed can prevent confusion and ensure everyone is on the same page.
  • Do ensure the form is signed by both you and your physician. A signature from a doctor is crucial for the order to be valid.
  • Do keep the DNR order in an accessible location. Make sure it’s easy for emergency personnel to find when needed.
  • Don’t fill out the form without fully understanding what it means. Take the time to ask questions and clarify any doubts.
  • Don’t forget to review and update the order as your health situation changes. It’s important to keep your wishes current.
  • Don’t assume that verbal instructions are enough. A written order is necessary for medical staff to follow your wishes.