Official Do Not Resuscitate Order Form for Wisconsin

Official Do Not Resuscitate Order Form for Wisconsin

A Do Not Resuscitate (DNR) Order in Wisconsin is a legal document that allows individuals to express their wishes about resuscitation efforts in case of a medical emergency. This form ensures that your preferences regarding life-saving treatments are respected by healthcare providers. If you want to make your wishes clear, consider filling out the DNR Order form by clicking the button below.

Fill Out Do Not Resuscitate Order Here

In Wisconsin, the Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals who wish to communicate their preferences regarding resuscitation efforts in the event of a medical emergency. This form is particularly significant for those with terminal illnesses or severe health conditions, as it allows them to make informed choices about their end-of-life care. The DNR Order must be completed by a physician, ensuring that it reflects a patient's wishes accurately and is in line with medical guidelines. It is important to note that the form must be signed by both the patient and the physician to be valid. Additionally, the DNR Order is recognized across various healthcare settings, including hospitals and long-term care facilities, providing peace of mind to patients and their families. Understanding the implications of this form is essential for anyone considering it, as it empowers individuals to take control of their healthcare decisions in a respectful and dignified manner.

Document Specifics

Fact Name Details
Definition The Wisconsin Do Not Resuscitate (DNR) Order form allows a person to refuse cardiopulmonary resuscitation (CPR) in case of cardiac or respiratory arrest.
Governing Law The DNR Order is governed by Wisconsin Statutes, specifically under Chapter 154.
Eligibility Any adult, or a minor with parental consent, can complete a DNR Order in Wisconsin.
Signature Requirement The form must be signed by the individual or their authorized representative, as well as a physician.
Form Availability The DNR Order form is available online through the Wisconsin Department of Health Services.
Revocation A DNR Order can be revoked at any time by the individual or their representative, verbally or in writing.
Healthcare Provider Obligations Healthcare providers must honor a valid DNR Order as long as it is properly completed and signed.
Emergency Services Emergency medical services (EMS) personnel are required to comply with the DNR Order when responding to a call.
Limitations The DNR Order only applies to resuscitation efforts and does not affect other medical treatments or interventions.

Key takeaways

Filling out and using the Wisconsin Do Not Resuscitate Order (DNR) form is an important process for individuals who wish to express their healthcare preferences. Here are some key takeaways to consider:

  1. The DNR form is a legal document that indicates a person's wishes regarding resuscitation efforts in the event of a medical emergency.
  2. It is essential for individuals to discuss their wishes with family members and healthcare providers before completing the form.
  3. The form must be signed by the patient or their legal representative, as well as a physician, to be valid.
  4. Once completed, the DNR form should be kept in a place where it can be easily accessed by emergency medical personnel.
  5. Healthcare providers are required to honor the DNR order as long as it is properly completed and signed.
  6. Individuals can revoke or change their DNR order at any time, but it must be done in writing.
  7. It is advisable to inform family members and caregivers about the existence of the DNR order to avoid confusion during emergencies.
  8. In Wisconsin, a DNR order is recognized across all healthcare settings, including hospitals, nursing homes, and at home.
  9. Regularly reviewing and updating the DNR order is recommended, especially after significant changes in health status.

Understanding these points can help ensure that individuals' healthcare preferences are respected and followed in critical situations.

Wisconsin Do Not Resuscitate Order Example

Wisconsin Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is based on Wisconsin state laws regarding advance directives. It allows you to make your wishes known concerning resuscitation in case of a medical emergency.

Please fill in the required information below:

  • Patient's Full Name: ______________________________
  • Date of Birth: ______________________________
  • Patient's Address: ______________________________
  • Patient's Phone Number: ______________________________

I, the undersigned, wish to decline cardiopulmonary resuscitation (CPR) and other life-sustaining procedures in accordance with Wisconsin statutes. My wishes are as follows:

  1. Signature of Patient: ______________________________
  2. Date: ______________________________

If the patient is unable to sign, a legal representative can sign on their behalf:

  • Representative's Full Name: ______________________________
  • Relationship to Patient: ______________________________
  • Signature of Representative: ______________________________
  • Date: ______________________________

Witness: This DNR Order must be witnessed by two individuals who are not related to the patient or to the representative:

  1. Name of Witness 1: ______________________________
  2. Signature of Witness 1: ______________________________
  3. Date: ______________________________
  1. Name of Witness 2: ______________________________
  2. Signature of Witness 2: ______________________________
  3. Date: ______________________________

This document should be presented to medical professionals to ensure your wishes are honored.

Important Facts about Wisconsin Do Not Resuscitate Order

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

A Do Not Resuscitate Order (DNR) is a legal document that allows a person to refuse cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest or respiratory failure. In Wisconsin, this order is designed to respect the wishes of individuals who do not wish to receive life-saving treatments that could prolong their dying process. It is important to have open discussions with family and healthcare providers about this decision to ensure that everyone understands your preferences.

Who can complete a DNR Order in Wisconsin?

In Wisconsin, a DNR Order can be completed by an adult who is capable of making informed decisions about their healthcare. This includes individuals who are 18 years or older and understand the implications of the order. If a person is unable to make decisions for themselves, a legal guardian or a healthcare proxy may be able to complete the DNR on their behalf. It is essential to ensure that the person completing the order is fully aware of the individual's wishes.

How do I obtain a DNR Order form in Wisconsin?

You can obtain a DNR Order form from various sources. The Wisconsin Department of Health Services provides a downloadable version of the form on its website. Additionally, healthcare providers, hospitals, and some community organizations may have copies available. Once you have the form, it is crucial to fill it out accurately and sign it in the presence of a witness, as required by state law.

What should I do after completing the DNR Order form?

After completing the DNR Order form, it is important to keep several copies in easily accessible locations. Share copies with your healthcare provider, family members, and anyone else who may be involved in your care. You should also consider placing a copy in a visible location in your home, such as on the refrigerator, to ensure that emergency responders can find it quickly if needed. Communication with your loved ones about your decision is key to ensuring that your wishes are honored.

Can a DNR Order be revoked or changed?

Yes, a DNR Order can be revoked or changed at any time. If you decide to change your mind about the order, simply notify your healthcare provider and anyone else who has a copy of the DNR. You may also want to complete a new form to clearly indicate your current wishes. It is important to communicate any changes to your family and caregivers to avoid confusion in emergency situations.

Documents used along the form

The Wisconsin Do Not Resuscitate Order form is an important document that allows individuals to express their wishes regarding resuscitation efforts in medical emergencies. Alongside this form, several other documents can help ensure that a person's healthcare preferences are respected. Below is a list of related forms and documents that are often used in conjunction with the DNR order.

  • Advance Directive: This document outlines a person's healthcare preferences, including decisions about medical treatments and interventions in the event of incapacitation.
  • Residential Lease Agreement: A All Georgia Forms includes essential details such as lease duration, rent amount, security deposits, and property use rules, serving to clarify the relationship between landlords and tenants in Georgia.
  • Power of Attorney for Healthcare: This legal document designates an individual to make healthcare decisions on behalf of another person if they are unable to do so themselves.
  • Living Will: A living will specifies the types of medical treatment a person wishes or does not wish to receive, particularly in end-of-life situations.
  • Physician Orders for Life-Sustaining Treatment (POLST): This form translates a patient's wishes regarding life-sustaining treatments into actionable medical orders, ensuring they are followed by healthcare providers.
  • Do Not Intubate (DNI) Order: Similar to a DNR, this order specifically states that a patient does not wish to be intubated or placed on a ventilator during a medical emergency.
  • Healthcare Proxy: This document allows individuals to appoint someone to make medical decisions on their behalf, ensuring their wishes are honored when they cannot communicate.
  • Emergency Medical Services (EMS) Information: This form provides critical information about a patient's medical history and preferences to emergency responders, facilitating appropriate care during emergencies.

Utilizing these forms in conjunction with the Wisconsin Do Not Resuscitate Order can help clarify and communicate a person's healthcare wishes. It is crucial to ensure that all documents are completed accurately and shared with relevant parties to avoid confusion during critical moments.

Consider More Do Not Resuscitate Order Forms for US States

What Is Dnr - This form is a vital part of advanced care planning, reflecting your personal healthcare philosophy.

How Old Do You Have to Be to Sign a Dnr - It’s important to distinguish between a DNR order and a living will, as they serve different purposes.

For those navigating real estate transactions in Georgia, understanding the necessary documentation is important. The Georgia property Deed form requirements are fundamental to ensure that ownership transfers are completed correctly and legally.

Georgia Dnr Form - A Do Not Resuscitate Order does not affect other medical treatments or interventions a patient may wish to receive.

What Does a Dnr Mean - This order may be accompanied by additional medical directives regarding overall treatment preferences.

Dos and Don'ts

When filling out the Wisconsin Do Not Resuscitate Order form, it is important to follow certain guidelines to ensure that your wishes are accurately documented. Below is a list of things you should and shouldn't do during this process.

  • Do ensure that you understand the implications of a Do Not Resuscitate Order before completing the form.
  • Do consult with your healthcare provider to discuss your wishes and any questions you may have.
  • Do sign and date the form in the appropriate sections to validate your request.
  • Do keep a copy of the completed form for your records and share it with your healthcare proxy.
  • Do review the form periodically to ensure it still reflects your current wishes.
  • Don't fill out the form without fully understanding its contents and consequences.
  • Don't sign the form without the presence of a witness, if required.
  • Don't assume that verbal instructions are sufficient; written documentation is necessary.
  • Don't forget to inform family members and caregivers about your Do Not Resuscitate Order.
  • Don't neglect to update the form if your health status or preferences change.