Fillable Do Not Resuscitate Order Template for the State of Illinois

Fillable Do Not Resuscitate Order Template for the State of Illinois

The Illinois 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. By completing this form, you ensure that your preferences for life-sustaining treatments are respected by healthcare providers. Understanding the implications of a DNR is crucial for making informed decisions about your medical care.

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In Illinois, the Do Not Resuscitate (DNR) Order form is an important document that allows individuals to express their wishes regarding medical treatment in critical situations. This form is designed for those who do not wish to receive cardiopulmonary resuscitation (CPR) or other life-saving measures if their heart stops beating or they stop breathing. It is essential for patients, families, and healthcare providers to understand the implications of this order. The DNR form must be completed and signed by a physician and the patient or their authorized representative. It is also crucial to ensure that the form is easily accessible to medical personnel in emergencies. By completing this document, individuals can ensure their healthcare preferences are honored, providing peace of mind for themselves and their loved ones during difficult times.

Your Questions, Answered

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

    A Do Not Resuscitate Order is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops beating or if they stop breathing. In Illinois, this order is legally recognized and must be followed by medical personnel.

  2. Who can request a DNR Order?

    A DNR Order can be requested by a patient who is at least 18 years old and has the capacity to make their own medical decisions. If the patient is unable to make decisions, a legally authorized representative, such as a family member or guardian, may request the order on their behalf.

  3. How is a DNR Order created in Illinois?

    To create a DNR Order, a patient or their representative must complete the Illinois DNR Order form. This form must be signed by the patient, or their representative, and a physician. It is important to ensure that the form is properly filled out and signed to be valid.

  4. Where should I keep the DNR Order form?

    The DNR Order form should be kept in a location that is easily accessible to healthcare providers, such as in the patient's medical records or on the refrigerator door. It is advisable to carry a copy of the form at all times, especially when visiting healthcare facilities.

  5. Can a DNR Order be revoked?

    Yes, a DNR Order can be revoked at any time by the patient or their authorized representative. To revoke the order, the individual should inform their healthcare provider and destroy any copies of the DNR Order form.

  6. Will a DNR Order affect other types of medical treatment?

    A DNR Order specifically pertains to resuscitation efforts and does not affect other medical treatments. Patients can still receive all other forms of medical care, including pain management, medication, and other interventions as deemed necessary by healthcare providers.

  7. What should I discuss with my healthcare provider regarding a DNR Order?

    It is important to have an open conversation with your healthcare provider about your wishes regarding end-of-life care. Discuss your health condition, treatment options, and the implications of a DNR Order. This ensures that your preferences are understood and respected.

Detailed Guide for Using Illinois Do Not Resuscitate Order

Completing the Illinois Do Not Resuscitate Order (DNR) form is an important step for individuals who wish to express their preferences regarding medical treatment in emergency situations. This form allows you to communicate your wishes clearly to healthcare providers. Below are the steps to fill out the form accurately.

  1. Obtain the Illinois Do Not Resuscitate Order form. You can find this form through healthcare providers or online resources.
  2. Carefully read the instructions provided with the form to ensure you understand the requirements.
  3. Fill in your full name, address, and date of birth in the designated sections of the form.
  4. Indicate your choice regarding resuscitation by checking the appropriate box. Make sure to review the options available to ensure your choice reflects your wishes.
  5. Sign and date the form. Your signature indicates that you understand the implications of your decision.
  6. Have a witness sign the form. The witness must be an adult who is not related to you and is not your healthcare provider.
  7. Provide a copy of the completed form to your healthcare provider and keep a copy for your records.

After completing the form, it is advisable to discuss your wishes with family members and healthcare providers. This ensures that everyone involved is aware of your preferences, which can facilitate better care aligned with your values.

Documents used along the form

When dealing with end-of-life care decisions in Illinois, several forms and documents complement the Do Not Resuscitate (DNR) Order. Each of these documents plays a critical role in ensuring that an individual's healthcare preferences are respected. Below is a list of these important forms.

  • Advance Directive: This document outlines a person's wishes regarding medical treatment and care in case they become unable to communicate their preferences. It can include instructions about life-sustaining treatments and appoint a healthcare proxy.
  • Healthcare Power of Attorney: This form designates an individual to make medical decisions on someone’s behalf if they are incapacitated. It ensures that someone trusted can advocate for the patient's wishes.
  • Living Will: A living will specifies what types of medical treatment a person does or does not want in situations where they cannot express their wishes. It focuses primarily on end-of-life care.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that outlines a patient's preferences for treatment in emergency situations. It is designed for those with serious illnesses and complements the DNR order.
  • Do Not Intubate (DNI) Order: This order indicates that a patient should not be intubated if they experience respiratory failure. It is often used in conjunction with a DNR order.
  • Medical Record Release Form: This form allows individuals to authorize the sharing of their medical information with designated parties, ensuring that healthcare providers have access to necessary information.
  • Patient Bill of Rights: This document outlines the rights of patients regarding their healthcare, including the right to make informed decisions about their treatment and care.
  • Authorization for Release of Information: This form permits healthcare providers to disclose a patient’s medical information to specified individuals or organizations, facilitating communication among caregivers.
  • Funeral Planning Documents: These documents include pre-arrangements for funeral services, burial, or cremation. They can help ensure that a person's final wishes are honored.

Understanding these documents is essential for ensuring that healthcare preferences are clearly communicated and respected. Each form serves a unique purpose and helps provide clarity in critical situations.

Similar forms

The Illinois Do Not Resuscitate (DNR) Order form shares similarities with the Advance Directive. An Advance Directive is a broader legal document that outlines a person's wishes regarding medical treatment when they cannot communicate. Like the DNR, it allows individuals to express their preferences about life-sustaining measures. Both documents aim to ensure that medical care aligns with a person's values and desires, especially in critical situations.

Another document akin to the Illinois DNR is the Physician Orders for Life-Sustaining Treatment (POLST). The POLST form translates a patient's preferences into actionable medical orders. While the DNR focuses specifically on resuscitation efforts, the POLST covers a wider range of medical interventions. Both forms require the signature of a physician and are designed to be honored by healthcare providers, ensuring that patients receive care consistent with their wishes.

The Medical Power of Attorney is also comparable to the DNR Order. This document allows individuals to designate someone to make medical decisions on their behalf if they become incapacitated. While the DNR specifies the desire not to receive resuscitation, the Medical Power of Attorney can encompass a broader scope of medical choices. Both documents empower individuals to maintain control over their healthcare even when they are unable to communicate their wishes directly.

The Living Will is another document that parallels the Illinois DNR. A Living Will outlines a person's preferences regarding end-of-life care, particularly when they are terminally ill or in a persistent vegetative state. Like the DNR, it is a way to communicate one's wishes regarding the use of life-sustaining treatment. Both documents serve to guide healthcare providers in making decisions that reflect the patient's values and desires.

The Declaration for Mental Health Treatment also shares similarities with the DNR Order. This document allows individuals to specify their preferences for mental health treatment in the event they become unable to make decisions. While the DNR focuses on physical health and resuscitation, both documents aim to ensure that a person's treatment aligns with their values. Each serves as a critical tool for communicating healthcare preferences in specific contexts.

Finally, the Do Not Intubate (DNI) order is closely related to the DNR form. The DNI specifically instructs healthcare providers not to insert a breathing tube if a patient cannot breathe on their own. While the DNR addresses resuscitation efforts more broadly, the DNI focuses on a particular aspect of emergency care. Both documents reflect a patient's wishes regarding critical medical interventions and help ensure that their preferences are respected in urgent situations.

Document Overview

Fact Name Description
Definition The Illinois Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation in the event of cardiac arrest or respiratory failure.
Governing Law This form is governed by the Illinois DNR Law, specifically the Illinois Compiled Statutes, Chapter 410, Act 50.
Eligibility Any adult, or a parent or legal guardian on behalf of a minor, can complete a DNR Order in Illinois.
Signature Requirement The DNR Order must be signed by the individual or their authorized representative, along with a physician's signature.
Form Accessibility The Illinois DNR Order form is available online through the Illinois Department of Public Health and can be printed for use.