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Homepage Attorney-Approved Do Not Resuscitate Order Form Printable Illinois Do Not Resuscitate Order Document

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Illinois Do Not Resuscitate Order

This document serves as a Do Not Resuscitate (DNR) Order in accordance with Illinois law. It reflects the wishes of the individual named below regarding emergency medical treatment.

Patient Information

  • Patient Name: ___________________________________________
  • Date of Birth: _________________________________________
  • Address: _____________________________________________

Physician Information

  • Physician Name: _________________________________________
  • Medical License Number: _______________________________
  • Contact Information: _________________________________

Order Statement

This Do Not Resuscitate Order directs medical personnel not to perform cardiopulmonary resuscitation (CPR) or any other resuscitative measures in the event that the patient suffers a cardiac arrest or respiratory arrest. This decision is made in consideration of the patient's medical condition and personal wishes.

Signatures

The undersigned authorize this DNR Order as described above.

  1. Patient Signature: _________________________ Date: _____________
  2. Physician Signature: ______________________ Date: _____________
  3. Witness Signature: ________________________ Date: _____________

This document should be placed in a visible location and communicated to all healthcare providers treating the patient.

Common mistakes

When filling out the Illinois Do Not Resuscitate (DNR) Order form, individuals often make several common mistakes that can lead to confusion or unintended consequences. Understanding these pitfalls can help ensure that the form accurately reflects one's wishes regarding medical treatment.

One frequent error is not signing the form. A signature is essential for the DNR order to be valid. Without it, healthcare providers may not recognize the document, and resuscitation efforts could occur despite the intent to avoid them. Always ensure that the form is signed and dated.

Another mistake is failing to include the name of the patient clearly. It is crucial to provide the full legal name as it appears on official documents. Ambiguities in the name can lead to misidentification and complications during emergency situations.

Some individuals forget to specify the date the DNR order takes effect. This omission can create uncertainty about when the order should be honored. It’s best to clearly indicate the effective date to avoid any confusion for medical personnel.

Additionally, people sometimes neglect to discuss their wishes with family members or healthcare providers. Open communication is vital. Family members should understand the patient’s desires to prevent misunderstandings during critical moments.

Another common issue is not updating the form when circumstances change. Life situations, such as a change in health status or personal beliefs, may necessitate a revision of the DNR order. Keeping the document current is essential for it to reflect the individual’s current wishes.

Some individuals may also overlook the importance of having witnesses sign the form. In Illinois, having two witnesses can help validate the DNR order. Without these signatures, there may be challenges to the order’s legitimacy, especially in emergency situations.

Lastly, people often forget to keep a copy of the DNR order in an accessible location. It should be readily available to healthcare providers. Keeping copies in places like the refrigerator or with a primary care physician can ensure that medical personnel can easily find and honor the order when needed.

Dos and Don'ts

When filling out the Illinois Do Not Resuscitate Order form, it is crucial to approach the task with care and consideration. Here’s a list of important dos and don’ts to keep in mind.

  • Do ensure you understand the implications of a Do Not Resuscitate Order.
  • Do discuss your wishes with your healthcare provider and family members.
  • Do fill out the form clearly and legibly to avoid any confusion.
  • Do sign and date the form to validate your wishes.
  • Do keep a copy of the completed form in an accessible place.
  • Don’t rush through the form; take your time to ensure accuracy.
  • Don’t assume that verbal instructions will suffice; written documentation is essential.
  • Don’t forget to review the form periodically, especially if your health situation changes.
  • Don’t neglect to inform emergency contacts about your Do Not Resuscitate Order.
  • Don’t overlook the importance of discussing your wishes with your healthcare team.

Similar forms

  • Living Will: A living will outlines an individual's preferences regarding medical treatment in situations where they cannot communicate their wishes. Like a DNR, it guides healthcare providers in making decisions about life-sustaining measures.
  • Healthcare Power of Attorney: This document designates a person to make healthcare decisions on behalf of someone else. Similar to a DNR, it ensures that a person's medical preferences are respected even if they are unable to express them directly.
  • Advance Directive: An advance directive combines a living will and a healthcare power of attorney. It provides comprehensive instructions about medical care preferences, including resuscitation efforts, making it closely related to a DNR.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that specifies what types of medical treatment a patient wishes to receive in emergencies. Like a DNR, it is intended to communicate a patient’s wishes clearly to medical personnel.
  • Do Not Intubate (DNI) Order: A DNI order specifically instructs healthcare providers not to insert a breathing tube if a patient cannot breathe on their own. This document complements a DNR by addressing a specific aspect of resuscitation efforts.
  • Power of Attorney for a Child: This essential document ensures that a trusted individual can make key decisions regarding a child's education and health during a parent's absence, providing peace of mind in various situations. To understand its importance and specifics, learn more.

  • Comfort Care Order: This order focuses on providing comfort rather than curative treatment. It shares similarities with a DNR in that both prioritize the patient’s quality of life over aggressive medical interventions.
  • End-of-Life Care Plan: An end-of-life care plan outlines a patient’s wishes regarding their care as they approach the end of life. Like a DNR, it emphasizes the importance of respecting individual preferences in medical decision-making.