Blank Do Not Resuscitate Order Template

Steps to Using Do Not Resuscitate Order

When faced with serious illness or at the end of life, some individuals prefer not to have lifesaving measures like CPR (cardiopulmonary resuscitation) performed. A Do Not Resuscitate (DNR) order is a legal form that signals healthcare providers not to conduct CPR if a person's breathing or heartbeat stops. Completing a DNR order is an important step in healthcare planning for those who wish to ensure their medical and end-of-life preferences are respected. Here is a guide to help you fill out a DNR order form properly.

1. Gather necessary information including the patient's full name, date of birth, and medical records number (if applicable).
2. Read the form carefully to understand the provisions contained within it. These provisions outline under what circumstances the DNR order should be applied.
3. Complete the patient information section by providing the patient's full name, date of birth, and any other required details.
4. If the patient is able to consent, they should sign and date the form in the designated area. If the patient is not competent or able to sign, a legal healthcare proxy or power of attorney may sign on their behalf. Be sure to note the relationship of the signer to the patient on the form.
5. The attending physician must review the form for accuracy, agree to the orders, and then sign and date the form in the designated area. The physician’s license number may also need to be included.
6. Discuss the completed form with the patient’s healthcare team to ensure it is added to the patient's medical records and is easily accessible in case of an emergency.
7. Inform close family members or designated proxies of the existence of the DNR order, where it is kept, and under what circumstances it should be presented to healthcare professionals.
8. Consider making additional copies of the signed form. Keep one with the patient, and provide others to a healthcare proxy, close family members, or friends as deemed appropriate.

Completing a DNR form is a significant decision that requires careful consideration and conversation with healthcare professionals, legal advisors, and loved ones. It is essential that everyone involved understands the patient’s wishes and the implications of this order. By following these steps, individuals can ensure their preferences regarding lifesaving treatments are respected.

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

   A DNR Order is a legal document that tells medical professionals not to perform cardiopulmonary resuscitation (CPR) if a person's breathing stops or if their heart stops beating. It's a decision made by a patient or their healthcare proxy in the interest of avoiding unnecessary suffering or in accordance with their wishes for end-of-life care. This ensures that medical care respects the patient’s desires.

2. Who can request a DNR Order?

   Any competent adult can request a DNR Order for themselves. This includes individuals with terminal illnesses or those who are at a high risk for sudden cardiac arrest. In cases where an adult cannot make decisions for themselves due to incapacity, a legal healthcare proxy or a family member authorized to make medical decisions can request it on their behalf.

3. How can one obtain a DNR Order?

   To obtain a DNR Order, an individual or their proxy must discuss it with a healthcare provider. The healthcare provider will review the patient's medical condition and overall goals of care. If a DNR is deemed appropriate, the provider will document the order in the patient’s medical record. Additionally, in some states, a formal DNR form must be completed and signed by both the patient or their legal representative and the healthcare provider.

4. Where does a DNR Order apply?

   DNR Orders are generally recognized in hospitals, by emergency medical services (EMS), and in other healthcare settings. However, the application of DNR Orders outside of hospital settings, such as at home or in public places, may require specific types of DNR orders or additional documentation, such as wearable identification indicating the individual has a DNR Order, to ensure it is followed by EMS personnel.

5. Can a DNR Order be revoked?

   Yes, a DNR Order can be revoked at any time by the individual who requested it or by their legal healthcare proxy. The revocation does not require a specific form but should be communicated clearly to the healthcare team, and, ideally, documented in the patient's medical records. It's advisable to also notify any healthcare personnel or facilities that were previously made aware of the DNR Order.

6. Does a DNR Order affect other treatments?

   A DNR Order specifically addresses the use of CPR in cases where the heart stops beating or the patient stops breathing. It does not apply to other treatments, such as pain relief, antibiotics, or nutrition, unless explicitly stated. Patients with a DNR Order still receive medical care aimed at providing comfort and treating other health conditions.

7. How does one discuss a DNR Order with family and healthcare providers?

   Discussing a DNR Order can be sensitive and requires clear communication. It’s beneficial to have these discussions early, ideally before a crisis occurs. Talk openly about your desires and reasons for considering a DNR Order with family members and your healthcare provider. These discussions help ensure that your wishes are understood and respected and allow your loved ones to prepare emotionally and mentally for such decisions.

Filling out a Do Not Resuscitate (DNR) Order form is a critical step for those who wish to have their healthcare desires respected, especially during emergencies. However, mistakes can occur during this process, compromising one's wishes. Understanding these mistakes can aid in ensuring that the form reflects true intent.

1. Not discussing the decision with a healthcare provider: Failing to have a conversation with a healthcare provider about the decision for a DNR can lead to misunderstandings about what it means and how it should be implemented in various medical situations.

2. Leaving blanks on the form: Every space on a DNR form is important. Skipping sections can lead to ambiguity, potentially causing healthcare providers to make decisions that are against the individual's wishes.

3. Improper witness or notary signatures: Most DNR orders require a witness or notary to validate the signature of the person filling out the form. Forgetting this step or not following the proper procedure can invalidate the entire document.

4. Lack of understanding of the form's contents: Not fully understanding all the choices and declarations on the form can lead to selections that don't accurately reflect the person's wishes.

5. Forgetting to share the decision with family or loved ones: Not informing family members or close friends about the DNR order can cause confusion and distress during emergency situations.

6. Failing to keep the form accessible: A DNR order can only be effective if it is easily accessible to healthcare professionals during an emergency. Keeping it in a hidden or hard-to-access location defeats its purpose.

7. Not reviewing and updating the form regularly: DNR preferences may change over time, especially if the individual's health condition changes. Regular reviews and updates to the form ensure that it still reflects current wishes.

8. Assuming all states recognize the form in the same way: State laws regarding DNR orders can vary. Assuming that a DNR order is universally recognized in every state can lead to complications and the form not being honored as intended.

When filling out a DNR order, careful consideration and proper completion of the form are paramount. Avoiding these common mistakes can help ensure that one's healthcare preferences are clearly understood and respected.

When considering a Do Not Resuscitate (DNR) Order, it's important to understand it is one of several documents used in planning for medical and end-of-life issues. These documents work together to ensure a person's healthcare wishes are known and respected, especially in situations where they might not be able to communicate these preferences. The DNR specifically addresses the desire not to have CPR or advanced cardiac life support if the heart stops or if breathing ceases. Accompanying this crucial form, several other documents often play key roles in comprehensive healthcare planning.

• Living Will - This document outlines what medical treatments a person does or does not want if they're unable to make decisions for themselves. It can detail preferences regarding life support, mechanical ventilation, and other life-sustaining measures.
• Medical Power of Attorney (POA) - Also known as a healthcare proxy, this document designates someone to make healthcare decisions on a person’s behalf if they are incapacitated. This POA can provide guidance on decisions beyond those related to resuscitation.
• Physician Orders for Life-Sustaining Treatment (POLST) - The POLST complements a DNR by providing detailed instructions on a wider range of life-sustaining treatments, including the use of antibiotics, tube feeding, and other interventions.
• Advance Directive - An advance directive combines a living will and a medical POA into one document. It lays out a person's healthcare preferences and appoints a healthcare proxy.
• Organ and Tissue Donation Form - This form records a person's wishes regarding organ donation at the time of death. It is essential for those who want to make this life-giving choice.
• Five Wishes Document - This unique document addresses personal, emotional, and spiritual needs in addition to medical wishes. It helps guide loved ones and healthcare professionals in making care decisions that align with the individual’s values.
• Emergency Contact Form - Though not directly a medical directive, this form is crucial for quickly contacting designated family members or friends in an emergency. It can support effective communication among healthcare providers, the POA, and other important contacts.

In conclusion, while a DNR order is indispensable for those who wish to decline CPR or advanced life support in critical situations, it works best within a context of comprehensive healthcare planning. These additional documents ensure that every aspect of a person's care preferences is documented, understood, and ready to guide healthcare professionals and loved ones when the need arises. Together, they create a robust framework for applying and respecting an individual's healthcare wishes.

A Living Will, much like a Do Not Resuscitate (DNR) Order, is a key document in healthcare planning. It outlines a person’s wishes regarding medical treatment in situations where they are unable to communicate their decisions. Both documents serve a crucial role in ensuring that healthcare providers follow the patient's preferences, particularly concerning life-sustaining treatments.

Another similar document is the Medical Power of Attorney (POA). This legal instrument authorizes a designated individual to make healthcare decisions on behalf of someone else, should they become incapacitated. It complements a DNR by allowing the appointed agent to make decisions that might not be specifically covered in a DNR order, including the refusal of resuscitation.

The Advance Directive combines elements of both a Living Will and a Medical POA, providing a comprehensive guide for healthcare providers. It outlines the person’s general wishes about their healthcare treatment, including end-of-life care, and often specifies conditions under which a DNR order should be applied.

A POLST (Physician Orders for Life-Sustaining Treatment) form is another document closely related to a DNR. It translates a patient's preferences into medical orders to be followed by healthcare providers, covering a broader range of instructions, including but not limited to resuscitation.

The Healthcare Proxy form designates another person to make healthcare decisions, similar to a Medical POA. This role becomes activated only when the individual becomes incapable of making decisions for themselves, ensuring decisions about a DNR or other medical treatments reflect the patient's wishes.

A Last Will and Testament, while primarily concerned with the distribution of an individual’s estate after death, can sometimes reference the individual’s desires regarding medical treatments or funeral arrangements. This indirect connection underlines its relevance to the broader context of end-of-life planning, akin to a DNR.

An Organ Donor Card or Registry Form indicates a person’s consent to have their organs and/or tissues donated after death. Although its primary purpose is different, it intersects with DNR orders in the context of end-of-life decisions, ensuring that the person’s wishes about their body are respected.

The Five Wishes Document is an advanced care planning tool that goes beyond medical aspects to address personal, emotional, and spiritual needs at the end of life. It includes specifying wishes about life support treatment, thus sharing the patient-centered focus of a DNR order.

An Emergency Medical Information Form provides emergency responders with critical medical information, including existing conditions, medications, and allergies. While not a directive, it may indicate the presence of a DNR order, ensuring that emergency care aligns with the individual's healthcare preferences.

Finally, the HIPAA Release Form, while not a directive on treatments, permits the sharing of protected health information with designated individuals or entities. Knowing a patient’s DNR status could be pivotal in a healthcare setting, ensuring that medical decisions, including those about resuscitation, are informed by comprehensive access to the patient’s medical history and preferences.

Filling out a Do Not Resuscitate (DNR) Order is a crucial process that requires attention to detail and accuracy. Below is a list of things you should and shouldn't do when completing this form:

1. Verify the patient's identity to ensure the DNR order aligns with the correct individual. This might include checking their full name, date of birth, and social security number.

2. Ensure that the form is filled out completely, leaving no necessary fields blank. Incomplete forms may not be legally binding.

3. Discuss the DNR order thoroughly with the patient (if possible) and their healthcare proxy or legal representative to make sure it reflects the patient's wishes.

4. Obtain the required signatures, including that of the patient (if able), the healthcare proxy, or a legal representative, as well as the attending physician.

5. Understand the state-specific requirements for DNR orders, as regulations can vary widely from one state to another.

• Don't forge or guess the patient's wishes if they're unable to communicate. Always consult with their designated healthcare proxy or legal representative.

• Don't leave the form in a place where it can't be quickly accessed in an emergency. A DNR order should be easily accessible to healthcare providers.

• Don't ignore state laws and regulations regarding DNR orders. Compliance with local laws is crucial for the DNR order to be valid and respected.

The understanding surrounding Do Not Resuscitate Orders (DNRs) can often be clouded by misconceptions, leading to confusion and distress among patients and their families. It's important to dismantle these myths to provide clarity and support informed decisions. Here are four common misunderstandings about DNRs:

• Misconception 1: A DNR applies to all medical treatment. Contrary to what some may believe, a DNR order specifically addresses the initiation of cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. It does not mean that other forms of medical care—such as pain management, oxygen therapy, or antibiotics—will be withheld. Patients with a DNR can still receive treatments aimed at comfort and preserving quality of life.
• Misconception 2: The decision to have a DNR is irreversible. Many people think that once a DNR is put in place, it cannot be changed. In reality, DNR orders are revocable at any time. A patient or their legally authorized representative can rescind the order if they change their mind, ensuring that choices about end-of-life care remain flexible and responsive to the individual's wishes and needs.
• Misconception 3: Only the elderly or terminally ill can have a DNR. This is not the case. While it’s true that DNR orders are often associated with individuals facing serious or life-limiting conditions, they can be requested by anyone who wishes to decline CPR for personal or medical reasons. The decision to have a DNR order should be based on informed discussions with healthcare providers, considering the patient's values, preferences, and overall health status.
• Misconception 4: A DNR order must be presented physically to be valid. While having a physical copy of a DNR order readily available can facilitate its implementation, many states have registries or other methods to verify a patient’s DNR status. Healthcare providers often use electronic health records and state registries to access these orders quickly. However, it's still advisable for patients and their families to communicate their wishes clearly and ensure that all relevant parties are informed of the DNR status.

By dispelling these myths, individuals and families can better navigate the complexities of health care decisions, ensuring that their wishes are respected and upheld. It’s crucial to engage in open and honest discussions with health care providers about DNR orders and other advanced directives to make informed choices that align with personal values and preferences.

Filling out a Do Not Resuscitate (DNR) Order is a significant step for anyone, indicating that in the event of a cardiac or respiratory arrest, no resuscitative efforts should be undertaken. While the concept might seem straightforward, the implications and considerations surrounding a DNR Order are complex. Here are ten key takeaways to understand when dealing with a DNR Order:

1. A DNR Order must be signed by both the patient or their legally authorized representative, and the attending physician, demonstrating a mutual agreement on the decision not to pursue resuscitation.
2. It is vital for the patient or their representative to have a thorough conversation with a healthcare provider to fully understand the medical implications of a DNR Order. This ensures that the decision is made with a clear understanding of the situation.
3. The presence of a DNR Order does not affect the quality or extent of any other medical care besides resuscitation. Patients will still receive comprehensive care aimed at comfort and the preservation of life up until a critical event.
4. DNR Orders are specific to the setting in which they were created. For instance, a DNR Order established in a hospital may not automatically apply in other settings like at home or in a long-term care facility, necessitating the creation of separate orders for these environments.
5. Legal requirements for DNR Orders can vary significantly from one jurisdiction to another. Always check the relevant laws in the patient's location to ensure that the order meets all legal requirements and is properly executed.
6. When filling out a DNR Order, it is essential to use clear and precise language to avoid any potential ambiguity or misinterpretation by healthcare professionals and family members.
7. In the event of an emergency, a DNR Order should be readily accessible to healthcare providers. Many patients opt to wear a DNR bracelet or carry a card in their wallet to inform emergency personnel of their DNR status.
8. DNR Orders can be revoked or modified at any time by the patient or their authorized representative, providing flexibility to adapt to changing circumstances or wishes.
9. It is recommended to review and discuss DNR Orders regularly with healthcare providers, especially if there is a significant change in the patient's health status or living situation.
10. Involving family members or close friends in discussions about DNR Orders can help ensure that a patient’s wishes are understood and respected by all relevant parties. Clear communication can prevent conflicts or confusion in emergency situations.

Understanding these key points can help individuals and their loved ones navigate the complexities of DNR Orders with confidence, ensuring that their healthcare wishes are respected during critical moments.