Fillable Do Not Resuscitate Order Document

Detailed Instructions for Using Do Not Resuscitate Order

A Do Not Resuscitate (DNR) order is a legal document that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event a patient's breathing stops or if the patient's heart stops beating. Completing a DNR order is a significant decision that requires thoughtful conversation with your family and healthcare provider. Below are clear steps to guide you through filling out a DNR order form to ensure your wishes are known and respected by healthcare professionals.

1. Gather Required Information: Before you start, make sure you have all necessary personal information, including your full legal name, date of birth, address, and contact details of your emergency contact or healthcare proxy.
2. Review the Form: Carefully read through the entire DNR form to familiarize yourself with its contents and requirements. If there are any sections that you do not understand, consider consulting a healthcare professional or legal advisor for clarification.
3. Fill in Personal Details: Enter your personal information in the designated fields, making sure to double-check for accuracy. This typically includes your name, date of birth, and address.
4. Medical Information: Some forms may require specific medical information or conditions to be listed. If applicable, include these details accurately.
5. Signature Requirement: Carefully review the signature section. Generally, the DNR order must be signed by the person the order is for, which could be you or someone you legally authorize to make decisions on your behalf. In many cases, the form also requires a physician's signature to be valid.
6. Witnesses and Notarization: Check if the form requires witnesses or notarization. If so, ensure this step is completed in accordance with your state's laws. This might involve having one or more individuals witness the signing of the document or having it officially notarized.
7. Copy and Distribute: Once the form is fully completed and signed, make several copies. Keep the original in a safe but accessible place, and give copies to your primary care physician, family members, or anyone else who might be involved in your healthcare decisions.
8. Inform Key People: Ensure that your family, close friends, and healthcare providers are aware of your DNR order and know where to find the document if needed.

Completing a DNR order is a personal decision that requires consideration of your values and medical wishes. Once filled out, this document plays a critical role in your healthcare plan, signaling to medical personnel your desire to avoid certain life-extending measures. Keep the document updated and communicate any changes in your wishes to your healthcare provider and loved ones.

What is a Do Not Resuscitate (DNR) Order?

A Do Not Resuscitate (DNR) Order is a written directive that specifies a person's wish not to receive cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS) if their heart stops beating or if they stop breathing. This order is used to respect the individual's wishes regarding end-of-life care.

Who can request a DNR Order?

Adults who are capable of making their own healthcare decisions can request a DNR Order. In cases where the individual is not able to make decisions for themselves, a legal guardian or someone with medical power of attorney can request a DNR on their behalf.

How can one obtain a DNR Order?

Obtaining a DNR Order involves several steps:

1. Consultation with a healthcare provider to discuss end-of-life care options and the implications of a DNR Order.
2. If the decision is made to proceed, the healthcare provider will fill out the DNR form.
3. The individual (or their authorized representative) must provide consent by signing the form.
4. The signed form must be placed in the individual’s medical record.

Is a DNR Order permanent?

No, a DNR Order is not permanent and can be revoked at any time by the individual for whom it was issued or their legal representative. To revoke a DNR, it is necessary to inform the healthcare provider verbally or in writing.

What happens if there is no DNR Order?

If there is no DNR Order in place, medical personnel will generally perform all possible life-saving measures, including CPR and ACLS, in the event of cardiac or respiratory arrest.

Where should a DNR Order be kept?

It is important to ensure the DNR Order is easily accessible in an emergency. Copies should be:

• Placed in the individual’s medical record
• Kept at home in a location where it can be quickly found by family members or emergency responders
• Carried by the individual, if possible

Does a DNR Order affect other medical treatments?

No, a DNR Order specifically concerns the use of CPR and ACLS in the event of cardiac or respiratory arrest. It does not limit other forms of medical treatment, including treatment for pain, respiratory support, or other interventions that may be necessary for the individual's comfort and care.

Can a DNR Order be transferred to a different state?

Because laws and regulations regarding DNR Orders can vary by state, it is important to consult with a healthcare provider or legal professional when moving to a different state. They can advise on whether a new DNR Order needs to be completed according to the laws of the new state.

Filling out a Do Not Resuscitate (DNR) Order form is a critical process that requires attention to detail and a clear understanding of one's wishes. Unfortunately, errors can occur, sometimes affecting the efficacy of these orders. The following outlines common mistakes that individuals may make during this process:

1. Not consulting with a healthcare professional: Before completing a DNR form, it is crucial to have a conversation with a healthcare provider. This discussion ensures that the individual fully understands the implications of a DNR order and how it affects emergency medical care. Skipping this step can lead to decisions that might not accurately reflect the person's wishes or medical best interests.
2. Failure to properly sign or date the form: A DNR order must be signed and dated to be legally valid. Sometimes, individuals fill out the form but overlook the signature and date sections, rendering the document ineffective. This oversight could lead to unwanted medical interventions in an emergency.
3. Lack of clarity in expressing wishes: DNR forms require clear expressions of an individual's wishes regarding resuscitation. Vague or ambiguous language can lead to confusion among healthcare providers and family members, potentially leading to actions that contradict the person's true preferences.
4. Incomplete information: Not filling out the entire form or leaving sections incomplete can lead to uncertainty and delays in critical situations. It's essential to provide all requested information to ensure that the DNR order is understood and followed correctly.
5. Failing to inform family members and healthcare proxies: After completing and signing a DNR order, it's vital to communicate this decision with close family members and any appointed healthcare proxies. If these parties are unaware of the existence or location of the DNR order, they may be unable to advocate for the person's wishes during emergency situations.

Ensuring a DNR form is accurately completed and effectively communicated safeguards an individual's wishes regarding emergency medical care. Avoiding these common mistakes is crucial for the document to serve its intended purpose.

In the realm of health care planning, especially when addressing end-of-life issues, the Do Not Resuscitate (DNR) Order form is among the most pivotal documents. However, it often operates within a broader framework of legal instruments designed to ensure that a person's health care preferences are known and respected. These documents serve to guide medical professionals as well as empower individuals and their appointed agents to make informed decisions regarding health care. Below are several critical forms and documents commonly used in conjunction with a DNR Order.

• Advance Health Care Directive: This comprehensive document allows individuals to detail their preferences for medical treatment in various scenarios should they be unable to communicate their wishes directly. It often includes a living will and health care power of attorney.
• Living Will: Specifically focuses on end-of-life care, outlining the types of medical interventions a person wishes to receive or avoid. It activates only under certain medical conditions, such as terminal illness or a permanent unconscious state.
• Health Care Power of Attorney: Designates a trusted individual to make health care decisions on behalf of the person, should they become unable to make these decisions themselves. It is broader than a DNR, covering all aspects of health care decision-making.
• Physician Orders for Life-Sustaining Treatment (POLST): A medical order that outlines a plan of care reflecting the patient's wishes regarding treatments they want or do not want to receive towards the end of life. It is intended for those at an advanced stage of illness or frailty.
• Durable Power of Attorney for Health Care: Similar to the Health Care Power of Attorney, it remains in effect even if the person becomes incapacitated. It allows the appointed agent to make a wider range of health care decisions.
• HIPAA Authorization Form: Allows specified individuals to access the person's health information, facilitating the sharing of medical information among caregivers and appointed decision-makers.
• Organ and Tissue Donation Form: Specifies the individual's wishes regarding organ donation upon death and may be important in the context of end-of-life planning.

Having a clear understanding of each document and how they interrelate can provide individuals with a robust framework for making thoughtful and personalized health care decisions. It is also crucial for ensuring that health care providers have clear instructions to follow, honoring the individual's wishes to the greatest extent possible. Properly executing and maintaining these documents, in accordance with state-specific laws and regulations, ensures that an individual's health care preferences are both known and legally protected.

A Living Will is quite similar to a Do Not Resuscitate (DNR) Order as it communicates a person's wishes regarding medical treatment in situations where they are unable to make decisions themselves. Like a DNR, a Living Will can specify which life-sustaining treatments someone does or does not want if they are critically ill or nearing the end of life. This could include decisions on the use of ventilators, artificial nutrition, or hydration, mirroring the intent behind a DNR to forego certain types of emergency or life-prolonging care.

The Health Care Power of Attorney (HCPOA) document also shares similarities with a DNR. However, instead of directly concerning specific treatment preferences, an HCPOA designates a person to make healthcare decisions on someone's behalf when they can’t do so themselves. This appointed agent can make decisions that align with the individual's healthcare preferences, including the enforcement or revocation of a DNR Order, depending on the situation and the individual’s previously expressed wishes.

An Advance Directive is another document related to a DNR. It typically combines elements of both a Living Will and a Health Care Power of Attorney. This document outlines a person’s healthcare preferences, including end-of-life care and the appointment of a healthcare proxy to make decisions if they are incapacitated. Advance Directives provide more comprehensive guidance than a DNR by covering a broader range of medical decisions while ensuring that the individual's stance on being resuscitated is clearly expressed and honored.

A POLST Form (Physician Orders for Life-Sustaining Treatment) also has a close connection with a DNR. Designed for seriously ill patients, the POLST form translates a patient's treatment preferences into medical orders. While a DNR specifically addresses the aspect of not initiating CPR (Cardiopulmonary Resuscitation) in the event of a cardiac or respiratory arrest, a POLST form can include this directive along with other detailed instructions regarding intubation, antibiotic use, and other life-sustaining treatments beyond the scope of a traditional DNR.

Filling out a Do Not Resuscitate (DNR) Order form is a significant step that requires careful consideration and clarity. Here are the things you should and shouldn't do to ensure the process meets your wishes and complies with legal standards.

Things You Should Do

1. Consult with your healthcare provider to fully understand the implications of a DNR order and ensure it aligns with your health care wishes.
2. Carefully read and follow the instructions on the form to avoid any confusion or errors that could make the document invalid.
3. Discuss your decision with close family members or loved ones to prepare them for what this means and to ensure your wishes are understood and supported.
4. Ensure the form is properly signed and witnessed as required by your state's laws. This may include a healthcare provider, a legal representative, or other designated individuals.
5. Keep the original document in an accessible location and provide copies to pertinent individuals, such as family members, caregivers, and your healthcare provider.

Things You Shouldn't Do

1. Fill out the form without a thorough discussion with your healthcare provider about the consequences and alternatives.
2. Leave parts of the form blank, assuming they are not important. Every section is crucial for the document to be considered legally valid.
3. Forget to update your DNR order if your health condition or wishes change. It’s important to keep all your health care directives up to date.
4. Only keep the form to yourself. If no one else knows about the DNR order or where it is stored, it may not be followed in an emergency.
5. Rely solely on verbal instructions to family or healthcare providers without having a DNR order in place, as this can lead to misunderstandings and complications.

When it comes to making end-of-life decisions, it is crucial to understand the facts around the Do Not Resuscitate (DNR) orders. Many misconceptions can lead to confusion and distress. Here's a list of common misunderstandings:

1. A DNR order means all treatments will stop. Actually, it only instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if breathing stops or the heart stops beating. Other treatments to provide comfort or address specific health issues can still be provided.

2. DNR orders are permanent and cannot be changed. In truth, these orders are completely reversible. A person can rescind their DNR order at any time, adjusting their end-of-life care preferences as needed.

3. The decision to issue a DNR order is made solely by doctors. This is a common misunderstanding. While healthcare professionals can provide advice, the decision to have a DNR order is ultimately made by the patient or, if they’re unable, by their family or legal guardians.

4. Only elderly people can have a DNR order. People of any age can have a DNR order if they have a terminal illness or wish not to receive CPR for personal or medical reasons.

5. Having a DNR order means you’re giving up on life. Choosing a DNR reflects a person’s preference for the type of care they wish to receive at the end of life. It’s a decision made after thoughtful consideration, focusing on the quality of life.

6. All hospitals automatically know if you have a DNR order. DNR orders need to be communicated to healthcare providers directly. Hospitals do not have a universal system to check if an individual has a DNR order.

7. DNR orders also mean "do not treat." This misconception leads to confusion. A DNR order only covers CPR, not other forms of medical intervention. Patients with DNR orders receive the same compassionate care for pain management and other conditions as anyone else.

8. DNR orders are only valid in the hospital. DNR orders can be applied both in hospital settings and at home, but it is important they are made part of the patient’s medical records and are easily accessible to emergency personnel.

9. If you have a DNR order, you cannot be intubated. Intubation may be used as part of the treatments that are not related to restarting the heart or breathing. The DNR order specifically addresses CPR, not other life-sustaining interventions.

10. Emergency medical technicians (EMTs) will not transport someone with a DNR order to the hospital. EMTs will provide transport and all necessary care within their scope, respecting the DNR order when applicable. Their focus remains on the comfort and wishes of the patient, including transport to a hospital if needed for non-CPR related issues.

Understanding what a DNR order entails can alleviate many fears and misconceptions. Making informed decisions ensures that care aligns with the wishes and values of the individual, promoting dignity and respect in end-of-life care.

When considering the completion and application of a Do Not Resuscitate (DNR) Order form, individuals should carefully reflect on several key aspects to ensure their wishes are respected and accurately documented. A DNR Order is a critical document for those who wish to decline resuscitation efforts in the event of cardiac or respiratory arrest. Below are seven essential takeaways to help guide you through filling out and using a DNR Order form:

• Understanding the Purpose: A DNR Order is intended to communicate an individual's preference not to undergo CPR (cardiopulmonary resuscitation) or advanced cardiac life support if their heart stops or they stop breathing. This decision is deeply personal and requires thoughtful consideration.
• Discuss with Healthcare Providers: Before completing a DNR Order form, it is crucial to have a detailed discussion with your healthcare provider. They can offer valuable insights into your current health status and the implications of a DNR Order based on your medical history and preferences.
• Legal Requirements Vary by State: The legality and specific requirements for a DNR Order can vary significantly from one state to another. Some states may require notarization, while others need witnesses or specific forms. Ensuring compliance with state laws is critical for the DNR Order to be honored.
• Clearly Document Wishes: When filling out the form, be as clear and explicit as possible about your wishes. Avoid ambiguous language that could lead to misinterpretation of your desires by medical personnel or family members.
• Communicate with Family and Loved Ones: It is equally important to discuss your decision with family members and loved ones to prepare them for the possible outcomes and ensure they understand your wishes. This conversation can be challenging but is essential for reducing stress and confusion during critical moments.
• Accessibility of the DNR Order: Once completed, the DNR Order should be kept in an easily accessible location. In an emergency, healthcare providers need to quickly verify your wishes. Informing close contacts, caregivers, and possibly your lawyer, where this document is stored, can prevent any delays in its execution.
• Review and Re-evaluate Periodically: Life circumstances and perspectives can change. As such, it's advisable to review your DNR Order periodically and make any necessary adjustments. Any changes must be documented, and the old order should be replaced by the updated version to prevent confusion.

Respecting an individual’s preferences at the end of their life is paramount. By thoughtfully considering and accurately documenting your wishes concerning resuscitation, you provide yourself and those around you with peace of mind during difficult times. A DNR Order is a powerful tool in ensuring that these preferences are respected.