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Attorney-Approved Do Not Resuscitate Order Form

A Do Not Resuscitate (DNR) Order is a legal document that allows individuals to refuse life-saving medical interventions in the event of cardiac arrest or respiratory failure. This form ensures that your wishes regarding resuscitation are respected by healthcare providers. Understanding and completing this form is crucial for making informed decisions about your medical care.

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Attorney-Approved Do Not Resuscitate Order Form

Contents

Do Not Resuscitate Order for Particular US States

Form Preview Example

Do Not Resuscitate (DNR) Order

This Do Not Resuscitate (DNR) Order is based on the laws of [Your State]. It serves as a formal request not to initiate resuscitative measures in the event of cardiac or respiratory arrest.

Patient Information:

Name: ______________________________
Date of Birth: ________________________
Address: _____________________________
Contact Number: ______________________

Declaration:

I, the undersigned, understand that if my heart stops or I stop breathing, I do not want cardiopulmonary resuscitation (CPR) or any other life-saving measures performed.

Patient Signature: _____________________________

Date: _____________________________

Witness Information:

Name: ______________________________
Signature: __________________________
Date: ______________________________

Healthcare Provider Information:

Name: ______________________________
License Number: _____________________
Contact Information: _________________

Important Notes:

This DNR Order should be placed in a visible location at home.
Provide copies to your healthcare provider and family members.
This order remains valid until revoked or updated.

Common mistakes

Filling out a Do Not Resuscitate (DNR) Order form is a significant decision that requires careful consideration. However, many individuals make mistakes that can lead to confusion or complications later. One common error is failing to clearly indicate the patient's wishes. It is essential to ensure that the DNR status is explicitly stated. Ambiguities can result in unwanted resuscitation efforts, which can be distressing for both the patient and their loved ones.

Another mistake often encountered is not involving all necessary parties in the decision-making process. Family members, healthcare proxies, and medical professionals should all be part of the conversation. When everyone is on the same page, it reduces the likelihood of disputes or misunderstandings about the patient's wishes. Communication is key to ensuring that the DNR order is honored.

People also tend to overlook the importance of updating the DNR form as circumstances change. A person's health status or personal preferences may evolve over time. Regularly reviewing and revising the DNR order ensures that it accurately reflects the current wishes of the patient. Neglecting this step can lead to situations where the form no longer represents the patient’s intentions.

Additionally, some individuals forget to sign the DNR order or fail to have it witnessed, which can render the document invalid. Proper signatures and witnesses are crucial for the legality of the form. Without these, healthcare providers may be unable to honor the patient's wishes, leading to unintended consequences.

Another frequent mistake is not discussing the DNR order with healthcare providers. Engaging in conversations with doctors and nurses about the implications of a DNR order can provide valuable insights. These professionals can help clarify what a DNR means in practice, ensuring that patients and families fully understand the implications of their choices.

Lastly, people sometimes fail to keep copies of the DNR order accessible. It is vital to have the document readily available in case of an emergency. Storing copies in multiple locations, such as with family members, at home, and with healthcare providers, can help ensure that the patient's wishes are known and respected when it matters most.

Dos and Don'ts

When filling out a Do Not Resuscitate (DNR) Order form, it's important to approach the process with care and consideration. Here’s a list of things you should and shouldn’t do to ensure your wishes are clearly communicated.

Do discuss your wishes with your healthcare provider to ensure you understand the implications of a DNR order.
Do involve your family members in the conversation so they are aware of your decisions.
Do ensure that the form is filled out completely and accurately to avoid any confusion later.
Do keep a copy of the completed DNR order in a place where it can be easily accessed by medical personnel.
Do review your DNR order periodically, especially if your health situation changes.

Don’t fill out the form under pressure or without fully understanding the consequences.
Don’t assume that verbal instructions are enough; always have a written order in place.
Don’t forget to sign and date the form, as an unsigned document may not be honored.
Don’t overlook the importance of informing your healthcare team about your DNR status.

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Similar forms

Living Will: A living will outlines an individual's preferences for medical treatment in situations where they cannot communicate their wishes. Like a DNR, it addresses end-of-life care decisions.
Durable Power of Attorney for Healthcare: This document designates someone to make healthcare decisions on your behalf if you become incapacitated. It complements a DNR by ensuring that your healthcare agent understands your wishes.
Advance Healthcare Directive: An advance directive combines a living will and a durable power of attorney. It provides instructions for medical care and designates an agent, similar to a DNR in its focus on end-of-life decisions.
Physician Orders for Life-Sustaining Treatment (POLST): POLST forms translate patient preferences into actionable medical orders. They are similar to DNRs but can address a wider range of treatment preferences.
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Comfort Care Order: This document emphasizes providing comfort and palliative care rather than aggressive treatment. It aligns with the principles of a DNR by focusing on quality of life.
Healthcare Proxy: A healthcare proxy appoints someone to make decisions about medical treatment if you are unable to do so. It works alongside a DNR to ensure that your preferences are honored.
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Do Not Hospitalize (DNH) Order: A DNH order indicates that a patient should not be admitted to a hospital for treatment. This document shares the goal of a DNR in prioritizing patient comfort and preferences.
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