Fillable Do Not Resuscitate Order Form for Pennsylvania State

Steps to Using Pennsylvania Do Not Resuscitate Order

Filling out a Pennsylvania Do Not Resuscitate (DNR) Order form is a significant step for individuals seeking to make clear their wishes regarding resuscitation attempts in emergencies. This document allows persons to refuse specific life-sustaining treatments in advance. Completing this form requires careful consideration and clear communication with healthcare providers. Below are the steps necessary to accurately complete the DNR Order form in Pennsylvania, ensuring that one's healthcare preferences are respected during critical moments.

1. Obtain the official Pennsylvania Do Not Resuscitate Order form. This can typically be sourced from a healthcare provider or the Pennsylvania Department of Health website.
2. Read the form thoroughly to understand the nature of the document and the implications of signing it. If you have questions, consider consulting a healthcare professional or legal advisor.
3. Fill in your full name, date of birth, and address in the designated sections at the top of the form to identify yourself as the patient.
4. Discuss your decision with your attending physician or healthcare provider. It is crucial they understand your wishes and agree that a DNR order is appropriate based on your medical condition.
5. Have your attending physician or a certified healthcare provider complete the medical eligibility criteria section. This part requires medical certification that you have a qualifying condition as defined under Pennsylvania law.
6. Sign and date the form in the presence of a witness if required. Some forms may require the patient's signature to be witnessed by an individual who is not related by blood or marriage and does not stand to benefit from the patient's death.
7. Ensure that your physician or authorized healthcare provider also signs and dates the form, thereby validating the DNR order.
8. Keep the original form in a location that is easily accessible in case of an emergency. Copies should also be provided to relevant family members, caregivers, and possibly your legal representative.
9. Inform close family members, friends, and caregivers of the existence of your DNR order, where it is stored, and discuss your wishes with them to ensure they understand your healthcare preferences.

After completing the Do Not Resuscitate Order form, it's important to periodically review and, if necessary, update it to reflect any changes in your health condition or in your decisions about your care preferences. Communication with your healthcare providers and loved ones about your DNR status and any changes to it will help ensure that your wishes are honored in critical healthcare decisions.

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

   A DNR order in Pennsylvania is a legal form that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if an individual's breathing stops or if their heart stops beating. This form is used when an individual, due to a terminal illness or specific health condition, decides that they do not want resuscitation attempts in these situations. It ensures that medical staff respect the patient's wishes regarding end-of-life care.

2. Who can request a DNR order in Pennsylvania?

   In Pennsylvania, the following individuals can request a DNR order:

   • An adult with the capacity to make their own healthcare decisions,
   • A healthcare agent named by the individual in a legally valid healthcare power of attorney,
   • A guardian appointed by the court to make medical decisions,
   • Parents or legal guardians of a minor,
   • The closest family member or members, when no healthcare agent or guardian is available.

   It's important for the requestor to discuss this decision with their healthcare provider to ensure it aligns with their health condition and end-of-life wishes.

3. How do I get a DNR order in Pennsylvania?

   To obtain a DNR order in Pennsylvania, you should first have a conversation with your doctor or healthcare provider about your wishes and the appropriateness of a DNR order based on your health condition. Your doctor will need to agree that a DNR order is in line with your health care wishes and your current medical condition. Once agreed, your doctor will fill out the DNR order form. After it's signed by both you (or your legal representative) and the doctor, it becomes official and should be kept in an easily accessible location.

4. Where should I keep my DNR order?

   Once your DNR order is completed and signed, it's crucial to keep it in a place where it can be easily found by emergency personnel or healthcare providers. Common places include:

   • On your refrigerator,
   • In your wallet or purse,
   • With your important documents,
   • Filed with your healthcare provider,
   • Shared with your healthcare agent or family members who are likely to be present in an emergency.

   Some people also choose to wear a DNR bracelet or necklace to indicate their DNR status visibly.

5. Can a DNR order be revoked or changed in Pennsylvania?

   Yes, a DNR order can be revoked or changed at any time by the individual for whom it was issued, as long as they have the capacity to make their own healthcare decisions. To revoke a DNR order, you should inform your healthcare provider of your decision verbally and in writing. A new DNR order will need to be completed and signed if you decide to reinstate or change your DNR instructions. It's also advised to destroy the old DNR form to avoid confusion and ensure your current wishes are followed.

Filling out a Pennsylvania Do Not Resuscitate (DNR) Order form involves some critical steps that need careful attention. Mistakes can potentially impact the effectiveness of your wishes regarding medical treatment. Awareness and understanding are key in avoiding common errors:

1. Not consulting with a healthcare professional: A crucial step often overlooked is failing to discuss the DNR form with a healthcare provider. This discussion ensures your choices are informed and reflect your current health status.

2. Incomplete information: Skipping sections or not filling out certain parts of the form can lead to its rejection or misinterpretation. It's imperative to provide all required details accurately.

3. Misunderstanding the DNR's scope: Sometimes people misconceive what a DNR does, expecting it to cover more than it actually does. A DNR specifically addresses not performing CPR; it doesn't apply to other treatments.

4. Not updating the form: Health wishes and conditions can change. Not updating your DNR to reflect these changes can result in a directive that doesn’t align with your current preferences or needs.

5. Forgetting to distribute copies: The form is only effective if healthcare providers are aware of it. Ensuring your primary care provider, family, and potentially even your local hospital have copies is essential.

6. Signature issues: Neglecting to sign the form or not having the required witnesses or notary sign (when applicable) invalidates the entire directive. Ensure all signature requirements are fulfilled.

7. Using an outdated form: Regulations and forms can evolve. Using an old version of the form might mean it gets overlooked or not accepted. Always check that you’re using the most current form available.

Steering clear of these mistakes can dramatically improve the clarity and efficacy of your DNR wishes. Remember, communication with family and healthcare professionals is paramount to ensure your healthcare preferences are honored.

In Pennsylvania, alongside the Do Not Resuscitate (DNR) Order form, there are several other documents that individuals often use to ensure their healthcare preferences are known and respected. These documents play vital roles in planning for medical care and ensuring that personal wishes are followed, especially in situations where an individual may not be able to convey their desires directly. Below is a list of documents commonly used together with the DNR Order form.

• Living Will: This document allows individuals to outline their preferences for medical treatment if they become unable to communicate or make decisions due to a severe illness or condition. It covers a range of treatments and indicates what should or should not be done.
• Health Care Power of Attorney (HCPOA): A Health Care Power of Attorney grants another person (often called a health care agent) the authority to make health care decisions on behalf of the individual if they are unable to do so themselves. This can cover a wide range of decisions, not just those related to life-sustaining treatment.
• Medical Orders for Life-Sustaining Treatment (POLST): The POLST form complements the DNR by providing more detailed instructions regarding end-of-life care preferences. Unlike the DNR, which specifically addresses not performing CPR, the POLST covers a broader range of life-sustaining treatments based on the patient's current health status.
• Advance Directive: An advance directive is a written statement of an individual's wishes regarding medical treatment, often encompassing both a living will and a health care power of attorney. This document is crucial for ensuring those wishes are carried out when the individual is not able to express them.
• Emergency Contact Form: Although not a legal document, the emergency contact form is essential. It provides healthcare professionals with the contact information of relatives or friends to be notified in case of an emergency. Having this form readily available can save valuable time and ensure that loved ones are informed quickly.

These documents, when used in conjunction, provide a comprehensive approach to managing healthcare decisions. They ensure that individuals' health care preferences are understood and adhered to by family members and healthcare providers, particularly in critical or end-of-life situations. Familiarity with and proper utilization of these forms can significantly impact the quality of care and peace of mind for both the individual and their loved ones.

A Living Will is similar to a Pennsylvania Do Not Resuscitate Order form because both documents allow individuals to express their preferences regarding medical treatments at the end of their lives. A Living Will typically outlines the types of life-sustaining treatments an individual wishes to decline or receive in the event that they are unable to communicate their decisions due to a medical condition, much like a Do Not Resuscitate (DNR) order specifies a person's wish not to receive CPR.

Healthcare Power of Attorney is another document akin to the DNR order. It designates an agent to make healthcare decisions on behalf of the individual if they are incapacitated. This often includes making decisions about life-sustaining treatment, echoing the DNR's purpose to direct certain types of care in specific medical situations.

An Advance Directive combines elements of both a Living Will and a Healthcare Power of Attorney, making it similar to a DNR in that it provides instructions for medical care when a person is incapacitated. It allows individuals to outline their healthcare preferences, including decisions about life-sustaining treatment, and appoint an agent to speak for them, thus encompassing the purposes of a DNR within a broader document.

A POLST (Physician Orders for Life-Sustaining Treatment) form closely mirrors the function of a DNR order. While a DNR specifically addresses the use of CPR in emergencies, a POLST covers a wider range of life-sustaining treatments, such as intubation and artificial nutrition. Both documents are physician orders and are intended for individuals with serious health conditions, guiding immediate treatment by emergency medical personnel.

A Five Wishes Document, while more comprehensive, shares similarities with a DNR order in that it addresses personal, spiritual, and medical wishes at the end of life. It goes beyond specifying medical treatments to include the individual's desires for comfort care, type of preferred treatment, and how they wish to be treated by others, integrating aspects of a DNR in a broader life-care plan.

A Medical Order for Scope of Treatment (MOST) is another document related to a DNR. It is used primarily for patients with advanced illnesses and provides specific instructions regarding the use of treatments, including CPR, antibiotics, and other life-sustaining measures. Like a DNR, it is a doctor's order that reflects the patient's wishes for end-of-life care.

An Emergency Medical Services (EMS) Do Not Resuscitate Order is closely related to the standard DNR but is specifically intended for emergency medical personnel. It informs first responders about a patient's wish to forego resuscitation attempts in the event of cardiac or respiratory arrest, providing a clear directive in emergency situations similar to the broader purpose of a DNR.

A Durable Power of Attorney for Health Care, while primarily a legal tool for appointing a healthcare agent, shares its objectives with a DNR in the sense that it can contain directives about medical treatments, including the refusal of life-sustaining procedures. Though its primary function is to establish an agent, the document often includes instructions that reflect the patient's healthcare preferences, akin to the specific instructions of a DNR.

In Pennsylvania, when filling out a Do Not Resuscitate (DNR) Order form, individuals make a critical decision about their healthcare, especially concerning emergency situations where they might not be able to express their wishes. Paying careful attention during this process is crucial to ensure that the individual’s desires are accurately recorded and respected. Below are essential dos and don'ts to consider:

Things You Should Do

1. Ensure that all the information provided on the form is accurate and complete. This includes verifying personal details, the specific orders, and any additional wishes or instructions that the individual wants to be followed.
2. Discuss the decision with a healthcare provider. A qualified healthcare professional can offer guidance, explain the implications of a DNR order, and help ensure it reflects the individual’s wishes and medical needs accurately.
3. Have the form signed and dated by the required parties, which typically include the individual (or their legal healthcare representative) and the physician. This legal acknowledgment is necessary for the DNR order to be valid and enforceable.
4. Keep copies of the completed DNR order in easily accessible places. This might include having a copy at home, in the individual's personal medical records, and notifying close family members or caretakers of its existence and location.

Things You Shouldn’t Do

1. Do not fill out the DNR form in haste or without fully understanding its implications. Making an informed decision requires careful thought and consultation with knowledgeable professionals and loved ones.
2. Avoid leaving sections of the form blank. Incomplete forms may cause confusion or be considered invalid, leading to unwanted medical interventions in an emergency.
3. Refrain from using ambiguous language or instructions. Clarity is paramount in medical orders to ensure that healthcare providers can follow the individual’s wishes without hesitation or misinterpretation.
4. Do not forget to update the DNR order if the individual’s health status or wishes change. Regular reviews and updates can ensure that the document remains accurate and reflective of the person’s current desires.

Misconceptions about the Pennsylvania Do Not Resuscitate (DNR) Order form are common, leading to confusion and distress for individuals and their loved ones. Clarifying these misconceptions ensures that individuals make informed decisions about their end-of-life care.

• All patients can request a DNR order themselves. In reality, only individuals who are of sound mind and either over 18, emancipated minors, or have a legal guardian authorized to make such decisions on their behalf can request a DNR order.

• A DNR order is the same as giving up on all medical treatment. This is not accurate. A DNR specifically directs that no cardiopulmonary resuscitation (CPR) be performed in the event of cardiac or respiratory arrest. Other treatments not related to reviving the heart or lungs can still be administered according to the patient's wishes or healthcare provider's advice.

• The form must be notarized to be valid. The truth is, Pennsylvania law does not require notarization for a DNR order to be considered valid. It must, however, be signed by the patient (or their authorized representative) and the physician.

• DNR orders are permanent and cannot be revoked. This is not the case. Patients or their authorized representatives can revoke a DNR order at any time through various methods, including orally, in writing, or by physically destroying the DNR form.

• Emergency medical services (EMS) personnel will not respond to calls for patients with a DNR order. EMS will still respond to emergency calls for these patients. Their approach, however, will be to provide comfort care and any requested non-resuscitative interventions.

• A DNR order also refuses life-sustaining treatments such as feeding tubes or ventilators. This misunderstanding can cause unnecessary fear. A DNR order strictly speaks to CPR and does not affect other forms of medical intervention unless specifically stated in an advance directive.

• DNR orders are only for the elderly or those with terminal illnesses. While those nearing the end of life or with terminal conditions often consider DNR orders, they're available to anyone meeting the state's criteria who wishes to avoid CPR in the event of cardiovascular or respiratory failure.

• Discussing a DNR is solely the responsibility of the healthcare provider. Although healthcare providers should initiate discussion about DNR orders as part of the care planning process, it's also essential for patients and families to communicate their wishes and concerns proactively.

Understanding the specifics of DNR orders in Pennsylvania helps individuals and their families navigate complex healthcare decisions with confidence and dignity.

Facing decisions about end-of-life care can be challenging, but understanding the Pennsylvania Do Not Resuscitate (DNR) Order form can help ensure that one's wishes are respected in critical moments. Here are some key takeaways about filling out and using this important legal document:

• Eligibility: To be eligible for a DNR order in Pennsylvania, an individual must either be diagnosed with a terminal condition by a physician or be permanently unconscious.
• Physician's Role: A DNR order must be signed by a physician, indicating that they have discussed the implications of the order with the patient or their legally authorized representative.
• Informed Decision: Before signing, it's crucial that the patient or their representative fully understand that a DNR order means CPR will not be performed in the event of cardiac or respiratory arrest.
• Completing the Form: Accurate completion of the form is essential. This includes providing clear patient identification and ensuring that the form reflects the patient’s current wishes regarding resuscitation.
• Legal Representation: If the patient is unable to make decisions for themselves, a legally authorized representative, such as a health care power of attorney, may sign the form on their behalf.
• Visibility: Once completed, the DNR order should be placed in a location where it is easily accessible to emergency personnel. Patients are also encouraged to wear a DNR bracelet or necklace.
• Revocation: It is important to note that a DNR order can be revoked at any time by the patient or their appointed representative. This decision should be communicated immediately to the physician and all relevant healthcare providers.
• Review and Update: Reviewing the DNR order periodically is recommended. This ensures that it continues to reflect the patient's current wishes, especially after any significant changes in health status.
• Communication is Key: Discussing one's decision to have a DNR order with family, close friends, and healthcare providers is essential. This helps ensure that everyone understands the patient's wishes and can act accordingly in an emergency.

Understanding and filling out the Pennsylvania DNR Order form with careful consideration can provide peace of mind to patients and their families, knowing that their wishes will be respected during critical times.