Fillable Do Not Resuscitate Order Template

1. What is a Do Not Resuscitate (DNR) Order?

   A Do Not Resuscitate Order is a legal document that informs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a person's heart stops beating or if they stop breathing. This order is typically established for individuals who wish to avoid aggressive life-saving measures in the event of a medical emergency.

2. Who can request a DNR Order?

   Generally, any adult who is capable of making their own healthcare decisions can request a DNR Order. In cases where the individual is unable to communicate, a legally authorized representative, such as a family member or designated healthcare proxy, may make this request on their behalf.

3. How do I obtain a DNR Order?

   To obtain a DNR Order, you should first discuss your wishes with your healthcare provider. They can help you understand the implications and guide you through the process of completing the necessary forms. Once the form is filled out and signed, it must be placed in a location where it can be easily accessed by medical personnel, such as in a medical file or on the refrigerator.

4. Is a DNR Order legally binding?

   Yes, a DNR Order is legally binding as long as it is properly executed according to state laws. It must be signed by the patient and a physician to be valid. Medical personnel are required to follow the order, provided it is clear and accessible at the time of an emergency.

5. Can I change or revoke my DNR Order?

   Yes, you can change or revoke your DNR Order at any time. To do this, you should inform your healthcare provider and complete a new order if necessary. It is important to ensure that all relevant parties, including family members and medical staff, are aware of any changes you make.

6. What should I discuss with my family regarding my DNR Order?

   It is crucial to have open conversations with your family about your wishes regarding resuscitation and end-of-life care. Discuss the reasons behind your decision, the implications of having a DNR Order, and any other preferences you may have for your healthcare. This ensures that your family understands your choices and can advocate for you if needed.

7. Will having a DNR Order affect my overall medical care?

   No, having a DNR Order does not mean you will receive less medical care. It only specifies that you do not want CPR in the event of cardiac arrest. You will still receive all other necessary medical treatments and interventions to manage your health and comfort.

Detailed Guide for Using Do Not Resuscitate Order

Filling out a Do Not Resuscitate (DNR) Order form is a significant step in expressing your healthcare preferences. Once completed, this document will guide medical professionals in understanding your wishes regarding resuscitation efforts in case of a medical emergency. Here’s how to fill out the form effectively.

1. Begin by obtaining the DNR Order form. This can typically be found at your healthcare provider's office or downloaded from a reputable medical website.
2. Read the instructions carefully. Familiarize yourself with the sections of the form to ensure you understand what information is required.
3. Fill in your personal information, including your full name, date of birth, and contact information. Make sure this information is accurate.
4. Designate a healthcare proxy if desired. This person will be responsible for making decisions on your behalf if you are unable to do so.
5. Clearly indicate your wishes regarding resuscitation. This may involve checking a box or signing a statement that expresses your preferences.
6. Provide any additional medical information that may be relevant, such as existing health conditions or treatments.
7. Sign and date the form. Your signature is crucial, as it validates your wishes.
8. Have the form witnessed, if required. Some states may require a witness or notary to ensure the document is legally binding.
9. Make copies of the completed form. Keep one for your records and provide copies to your healthcare proxy and medical providers.

Once the form is filled out and distributed, it's essential to communicate your wishes with family members and your healthcare team. This will help ensure that everyone is on the same page regarding your preferences, providing peace of mind for you and your loved ones.

A Do Not Resuscitate (DNR) Order is an important document that indicates a person's wishes regarding resuscitation efforts in the event of a medical emergency. In addition to the DNR Order, several other forms and documents may be relevant for ensuring that an individual's healthcare preferences are honored. Below is a list of these documents, each serving a specific purpose in the realm of healthcare decision-making.

• Advance Directive: This document outlines a person's preferences for medical treatment in situations where they may not be able to communicate their wishes. It can include instructions on life-sustaining treatments, organ donation, and other healthcare decisions.
• Healthcare Power of Attorney: This form designates a specific individual to make healthcare decisions on behalf of the person if they become incapacitated. It ensures that someone trusted can advocate for the person's wishes.
• Living Will: A living will is a type of advance directive that specifically details the types of medical treatments a person wishes to receive or avoid in end-of-life situations. It serves as guidance for healthcare providers and family members.
• POLST Form (Physician Orders for Life-Sustaining Treatment): This is a medical order that outlines a patient's preferences for life-sustaining treatments. It is often used for individuals with serious illnesses and is signed by a physician.
• Do Not Intubate (DNI) Order: Similar to a DNR, a DNI order specifies that a person does not wish to be intubated or placed on a ventilator. This document is crucial for clarifying preferences regarding respiratory support.
• Organ Donation Registration: This document indicates a person's wishes regarding organ donation after death. It can be included in an advance directive or completed separately, and it ensures that the person's intentions are known.
• Medical Records Release Form: This form allows individuals to authorize the sharing of their medical records with designated parties. It can be important for ensuring that healthcare providers and family members have access to necessary information.

Understanding and completing these documents can provide peace of mind for both individuals and their families. They ensure that healthcare decisions align with personal values and preferences, particularly in critical situations. It is advisable to discuss these forms with a healthcare provider or legal professional to ensure they accurately reflect one's wishes.

A Living Will is a legal document that outlines an individual’s preferences regarding medical treatment in the event they become unable to communicate their wishes. Similar to a Do Not Resuscitate (DNR) Order, a Living Will typically specifies which medical interventions a person does or does not want, particularly concerning life-sustaining treatments. Both documents serve to ensure that a patient’s healthcare decisions are honored, reflecting their values and desires in critical situations.

A Healthcare Power of Attorney grants a designated person the authority to make medical decisions on behalf of someone who is incapacitated. This document is similar to a DNR Order in that it can include specific instructions regarding resuscitation and other life-sustaining measures. While a DNR focuses solely on resuscitation efforts, a Healthcare Power of Attorney encompasses a broader range of healthcare decisions, allowing for a trusted individual to advocate for the patient’s wishes in various medical scenarios.

An Advance Directive combines elements of both a Living Will and a Healthcare Power of Attorney. It provides guidance on medical treatment preferences and designates a healthcare proxy. Like a DNR Order, an Advance Directive ensures that a patient’s choices about resuscitation and other treatments are respected. The comprehensive nature of an Advance Directive allows individuals to express their wishes clearly, covering multiple aspects of medical care rather than focusing solely on resuscitation.