Free Do Not Resuscitate Order Document

How to Use Do Not Resuscitate Order

A Do Not Resuscitate (DNR) Order is a crucial document for individuals who wish to express their preference against receiving cardiopulmonary resuscitation (CPR) in the event their heart stops or they stop breathing. It's a deeply personal decision that requires thoughtful consideration. Once the choice is made, properly completing and signing the DNR form ensures that your wishes are known and respected by healthcare providers. Here's a guide on how to fill out a Do Not Resuscitate Order form correctly.

1. Begin by clearly printing the patient's full name, date of birth, and address at the top of the form to ensure there is no confusion about whose wishes are being recorded.
2. Read through the entire form carefully before filling anything out. This ensures you understand the nature and implications of the order.
3. If the form requires, include the patient’s medical record number or other identification number used by the healthcare provider to maintain the patient's medical records.
4. A section of the form may require specifying the medical conditions leading to the DNR order. Fill this part in consultation with the patient's healthcare provider to ensure accuracy.
5. Most DNR forms must be signed by the patient, or if the patient is unable to do so, by a legally authorized representative. Locate the signature line intended for the patient or the representative and sign accordingly.
6. In addition to the patient or representative’s signature, the form often requires the signature of a witness. The witness verifies the identity of the signer and confirms the signer’s intention. The witness then signs and dates the form in the designated area.
7. Another critical component of the form is the physician's section. The attending physician must review the DNR order, agree that it is appropriate, and add their signature along with the date to validate the order. Some forms may also require the physician's license number.
8. Ensure all dates on the form are accurate and clearly written. This includes the date the form was filled out, the date of signature by the patient or representative, the witness’s signature date, and the physician’s signature date.
9. After completing the form, make several copies. Keep the original in a safe but accessible place, provide a copy to your primary care physician, and consider giving copies to close family members or a legal representative.
10. Finally, it is important to revisit and, if necessary, update your DNR order periodically, especially if your health situation changes. This might involve filling out a new form and replacing the old one in all locations where it was distributed.

Understanding and filling out a Do Not Resuscitate Order form is a significant step in ensuring that your healthcare preferences are known and respected. While it may seem like a challenging process, following these steps can provide peace of mind for you and your loved ones.

What is a Do Not Resuscitate Order (DNR)?

A Do Not Resuscitate Order, or DNR, is a medical directive written by a doctor at the request of a patient or their authorized health care proxy. It states that in the event the patient's breathing stops or their heart ceases to beat, medical personnel should not attempt CPR (cardiopulmonary resuscitation) or other life-sustaining measures.

Who can request a DNR order?

Any competent adult can request a DNR order for themselves. If the person is not able to make decisions due to a medical condition, a legal guardian or someone holding a durable power of attorney for health care decisions can request a DNR order on their behalf.

Where does a DNR order apply?

A DNR order typically applies in healthcare settings such as hospitals and nursing homes. Some states also provide for out-of-hospital DNR orders, which are intended to instruct emergency medical personnel not to perform CPR in the event they are called to the patient's home or another non-hospital setting.

How can a DNR order be revoked?

A DNR order can be revoked at any time by the patient if they are competent to make their own medical decisions, or by their legally authorized representative. This can be done verbally or in writing, depending on the state's requirements. The revocation should be communicated to the healthcare team immediately to ensure that the patient's medical record reflects their current wishes.

Does having a DNR order affect the quality of other treatments?

No, a DNR order only affects the use of CPR and other resuscitative measures in the event that breathing or heartbeat stops. It does not impact the provision of other types of medical care, such as pain management, oxygen, or antibiotics, unless specifically stated otherwise in advance directives. Patients with a DNR order still receive comprehensive medical treatment tailored to their needs and wishes.

Filling out a Do Not Resuscitate (DNR) Order form is an important step for those who wish to specify their desires regarding resuscitation attempts in emergency situations. However, mistakes can occur in the process, leading to potential misunderstandings or the wishes of the individual not being followed. Here are five common mistakes to watch out for:

1. Not discussing the decision with family members or healthcare providers in advance. This can lead to confusion or disputes at critical moments, making it essential that the individual's wishes are communicated clearly to all relevant parties beforehand.

2. Forgetting to update the form after significant changes in health status. As conditions evolve, what makes sense at one point may not hold true later, thus regular reviews and updates of the DNR order ensure it accurately reflects current healthcare wishes.

3. Incomplete form filling is another common mistake. Missing critical information can invalidate the form or lead to misinterpretation of the patient's wishes. It's crucial to fill out every required section accurately.

4. Failing to have the form properly witnessed or notarized, if required by state law. The absence of a proper witness or notarization can result in the DNR order not being legally recognized, which might lead to unwanted resuscitation efforts.

5. Not making the DNR order accessible. Once completed, the form should be stored in an easily accessible location, and copies should be shared with family members and healthcare providers. If the form is not readily available in an emergency, it's as if it doesn't exist at all.

By avoiding these mistakes, individuals can help ensure that their healthcare wishes regarding resuscitation are understood and respected.

While a Do Not Resuscitate (DNR) Order is crucial for those who wish to decline life-saving measures in dire situations, there are other forms and documents that often accompany it to ensure a person's healthcare wishes are fully understood and respected. These documents can be as important as the DNR itself, guiding families and healthcare providers through difficult decisions during critical times.

• Living Will: This document allows individuals to outline their preferences for medical treatments in various scenarios where they might be unable to communicate their wishes. A living will can specify which life-sustaining treatments, if any, one wishes to receive.
• Health Care Power of Attorney (HCPOA): This legal document designates another person (a proxy) to make healthcare decisions on an individual's behalf if they become incapable of making informed decisions themselves. The HCPOA can include specifications about what kinds of decisions the proxy can make, including accepting or refusing certain types of medical care.
• POLST (Physician Orders for Life-Sustaining Treatment): A POLST form complements a DNR order by providing more detailed instructions about other types of medical interventions that a person wishes to avoid or receive. Unlike a DNR, which is strictly about resuscitation, a POLST covers a broader range of life-sustaining treatments.
• Advance Directive: This is a broader term that can include a living will and a health care power of attorney. It's a document or a set of documents that specify what actions should be taken regarding a person's health if they are no longer able to make decisions for themselves due to illness or incapacity.

Together with a DNR order, these documents provide a comprehensive framework for addressing an individual's medical and end-of-life preferences. They ensure that the healthcare team, together with the family and loved ones, are aware of and can honor the patient's wishes, making a challenging and emotional time slightly easier to navigate with the assurance that decisions being made align with what the patient would have wanted.

A Do Not Resuscitate Order (DNR) shares similarities with an Advance Directive, which is another important document in healthcare. Both documents guide medical professionals on how to proceed with a patient's care when the patient cannot communicate their wishes. Whereas a DNR specifically instructs not to perform CPR, an Advance Directive can provide broader instructions about treatments and life-sustaining measures a person wishes to avoid or receive.

Living Wills are closely related to DNR orders in that they express a person’s preferences regarding medical treatment in life-threatening situations. Living Wills typically include more detailed healthcare directives than a DNR, addressing conditions other than cardiac or respiratory arrest, such as feeding tubes and ventilator use, offering a comprehensive overview of a patient’s wishes.

Healthcare Power of Attorney (HCPA) documents also have similarities to DNR orders. An HCPA allows an individual to appoint someone else to make healthcare decisions on their behalf if they become unable to do so. Unlike a DNR, which provides specific instructions for a particular medical situation, an HCPA designates a proxy for a range of medical decisions, potentially including the decision to implement a DNR order.

POLST (Physician Orders for Life-Sustaining Treatment) forms considerably resemble DNR orders, as both are designed to communicate a patient’s wishes about life-sustaining treatments. However, POLST forms are more comprehensive, covering various treatments beyond CPR, such as mechanical ventilation and antibiotic use, and are intended for seriously ill or frail patients for whom a healthcare provider would not be surprised by death within a year.

Medical Orders for Scope of Treatment (MOST) are akin to DNR orders in their purpose to ensure that a patient’s wishes concerning life-sustaining treatments are followed. Like POLST forms, MOST documents go beyond the scope of DNR orders to include directives about a wider range of medical interventions and are often used in settings where the patient has a serious or terminal condition.

A Five Wishes document expands on the idea behind a DNR by addressing personal, spiritual, and emotional needs alongside medical wishes. It asks individuals to consider their desires for comfort care, how they want to be treated, what they want their loved ones to know, and more, in addition to their preferences for medical treatment like those outlined in a DNR.

Guardianship Agreements, while broader in scope, share an essential purpose with DNR orders. These agreements allow an appointed guardian to make decisions on behalf of an individual who is no longer capable of making informed choices, potentially including health care decisions and the implementation of a DNR order, among many other responsibilities.

Mental Health Advance Directives are specific types of advance directives focused on psychiatric care. They detail a person’s preferences for treatment during a mental health crisis, which may include medications, hospitalization preferences, and even preferences on life-sustaining treatments under certain conditions, echoing the anticipatory planning of a DNR.

Lastly, an Organ and Tissue Donation form, while primarily focused on posthumous decisions, shares the forward-looking planning aspect with DNR orders. Both are pre-emptive decisions made about one’s body, with organ donation forms specifically directing the use of one's organs after death, which can sometimes influence end-of-life care considerations and discussions.

Filling out a Do Not Resuscitate (DNR) Order form is a significant step in healthcare planning, ensuring that a person's wishes regarding life-saving treatments are respected. When filling out a DNR form, it's crucial to proceed thoughtfully and accurately. Here are some important do's and don'ts to guide you through the process.

1. Consult with a healthcare provider: Before signing a DNR order, discuss it with a doctor or healthcare professional to understand its implications fully.
2. Ensure clarity in writing: Fill out the form with clear, legible handwriting to avoid any potential misunderstandings or errors in emergency situations.
3. Use accurate personal information: Double-check that all personal identification details like name, date of birth, and Social Security number are correct and up to date.
4. Include contact information: Provide the contact details of a family member, healthcare proxy, or legal representative who can confirm your wishes if needed.
5. Sign and date the form: Make sure the DNR order is legally binding by signing and dating it, usually in the presence of a witness or notary, depending on the state's requirements.

• Don’t fill out the form alone: Discussing your wishes with loved ones and a healthcare provider ensures that they understand and will support your decisions.
• Don’t forget to update it: Review and, if necessary, update your DNR order periodically, especially after major health changes or life events.
• Don’t overlook state laws: Each state has its specific regulations and forms for DNR orders, so make sure the form complies with your state's laws.
• Don’t use vague language: Be as specific as possible about your healthcare wishes to prevent any ambiguity during critical moments.
• Don’t fail to distribute copies: Ensure your healthcare provider, a trusted family member, and, if applicable, your healthcare attorney, have copies of your completed DNR form.

When discussing a Do Not Resuscitate (DNR) Order, it's crucial to dispel common misconceptions that may surround its purpose and application. A clear understanding can empower individuals and their families, allowing for informed decisions regarding end-of-life care. Here are eight common misunderstandings about DNR orders:

• Misconception: DNR orders are only for the elderly. Truth: DNR orders concern a person's wishes regarding resuscitation, not their age. Individuals of any age with severe health conditions may consider a DNR order relevant to their care plans.
• Misconception: Having a DNR means receiving no medical treatment. Truth: A DNR order specifically addresses CPR (cardiopulmonary resuscitation) and does not restrict other forms of medical care or treatments aimed at providing comfort and addressing other health issues.
• Misconception: Doctors decide if a patient needs a DNR order. Truth: While physicians can offer advice, the decision to create a DNR order rests with the patient or, in some cases, the patient’s health care proxy or family, based on the patient's wishes and values.
• Misconception: A DNR order is permanent and cannot be changed. Truth: A DNR order can be revised or revoked by the patient at any time, should their situation or wishes change.
• Misconception: DNR orders negatively impact the quality of end-of-life care. Truth: The purpose of a DNR order is to ensure that a patient's wishes regarding CPR are respected. It is not an indicator of the quality of end-of-life care a patient will receive, which remains a priority for healthcare providers.
• Misconception: DNR orders apply to all hospital and emergency situations. Truth: DNR orders are specifically related to not initiating CPR in the event of cardiac or respiratory arrest. They do not apply to other medical interventions or emergency care situations unless explicitly stated.
• Misconception: Only a legal document can establish a DNR order. Truth: While formal documentation is strongly recommended to ensure a person's wishes are respected, in some cases, verbal agreements with a healthcare provider, documented in the patient's medical record, can serve as a temporary DNR order until formal documentation is completed.
• Misconception: DNR orders are understood uniformly across all healthcare settings. Truth: The interpretation and implementation of DNR orders can vary by institution and jurisdiction. It is important for patients and their families to discuss the specifics and implications of a DNR order with healthcare providers to ensure clarity and alignment with the patient’s wishes.

• A Do Not Resuscitate (DNR) Order form is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event a patient's breathing stops or the heart stops beating.

• The form must be completed by a licensed healthcare provider, based on the patient's wishes and medical condition. It's important that this discussion is informed and includes an understanding of the patient's health status and prognosis.

• DNR forms are specific to each state, so it's essential to use the form that complies with the laws and regulations of the state where the patient resides or is receiving care. This ensures the document's legality and efficacy.

• Having a DNR form does not mean that all medical treatments will be stopped. Patients with a DNR can still receive medications, surgeries, and other interventions to treat injuries and illnesses. The form specifically addresses the use of CPR in emergency situations.

• For a DNR order to be effective, it must be readily available and presented upon request to healthcare providers and emergency personnel. Some people choose to wear medical alert bracelets or carry wallet cards indicating their DNR status.

• It's advisable to review and potentially update the DNR order periodically, especially if there is a significant change in the patient's health status. This ensures the order reflects the current wishes of the patient.

• Communication is key. Patients should discuss their wishes with family members, healthcare proxies, and healthcare providers to ensure their decisions are understood and will be honored.