Smart Legal Forms

Smart Legal Forms
Homepage ⇢ Attorney-Approved Do Not Resuscitate Order Form ⇢ Printable Ohio Do Not Resuscitate Order Document
Contents

Form Preview Example

Ohio Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is in accordance with Ohio state law regarding advance directives and patient care preferences.

Patient Information:

  • Name: ______________________________
  • Date of Birth: ______________________
  • Address: ____________________________
  • City, State, Zip Code: ________________

Healthcare Provider Information:

  • Primary Physician Name: ________________
  • Office Address: ________________________
  • Phone Number: _________________________

Order Statement:

I, ______________________________ (Patient), do hereby declare that I do not wish to receive cardiopulmonary resuscitation (CPR) or advanced life support in the event of a cardiac or respiratory arrest.

This order is based on my understanding of my current medical condition and my personal healthcare preferences.

Signature:

  • Patient Signature: _______________________ Date: ____________
  • Designation of Healthcare Power of Attorney (if applicable): ___________________
  • Signature of Attorney-in-Fact: ________________ Date: ____________

Witnesses:

  1. Witness Name: _______________________ Signature: ______________ Date: ____________
  2. Witness Name: _______________________ Signature: ______________ Date: ____________

This DNR Order must be presented to all healthcare providers and included in the patient’s medical record to ensure it is honored.

Common mistakes

When filling out the Ohio Do Not Resuscitate Order form, many individuals unintentionally make mistakes that can lead to confusion or complications in critical situations. One common error is failing to provide the necessary signatures. Both the patient and their physician must sign the form for it to be valid. Without these signatures, emergency personnel may not honor the wishes outlined in the document.

Another frequent mistake is not clearly indicating the patient's wishes. It is crucial to ensure that the instructions are explicit and unambiguous. If the language used is vague or open to interpretation, medical staff may hesitate to follow the order, potentially resulting in unwanted resuscitation. Clarity is essential in conveying the patient's desires.

Additionally, people often overlook the importance of updating the form. Life circumstances can change, and so can a person's wishes regarding resuscitation. If a patient’s health status changes or if they have a change of heart, it is vital to revise the Do Not Resuscitate Order accordingly. Failing to do so can lead to situations where outdated wishes are followed instead of the patient’s current preferences.

Lastly, individuals may neglect to distribute copies of the completed form to relevant parties. It is important to share the Do Not Resuscitate Order with family members, caregivers, and medical providers. Without proper distribution, there is a risk that the order may not be readily accessible when needed, which could lead to unnecessary interventions contrary to the patient’s wishes.

Dos and Don'ts

When filling out the Ohio Do Not Resuscitate Order form, it is essential to follow specific guidelines to ensure that your wishes are accurately documented. Below is a list of things you should and shouldn't do.

  • Do ensure you understand the implications of a Do Not Resuscitate Order.
  • Do discuss your decision with your healthcare provider and family members.
  • Do fill out the form completely, providing all necessary information.
  • Do sign and date the form to make it valid.
  • Do keep a copy of the completed form in a safe place.
  • Don't leave any sections of the form blank, as this may cause confusion.
  • Don't assume that verbal instructions are enough; written documentation is crucial.
  • Don't forget to inform your healthcare team about the existence of the order.
  • Don't hesitate to update the form if your wishes change over time.
⇓ PDF

Other Do Not Resuscitate Order State Forms

Dnr Forms - A DNR order can vary in wording and requirements depending on state laws.

Texas Dnr Form - Patients may find it comforting to know that their wishes about end-of-life care are documented and respected.

The Employment Verification form is a crucial document used by employers to confirm the employment status of an individual. This form serves as a means of validating a person's work history, including job titles, dates of employment, and responsibilities, and can be accessed through this link: https://documentonline.org/blank-employment-verification/. Understanding its purpose can benefit both job seekers and employers alike.

How Do I Get a Dnr - Patients are encouraged to discuss their wishes with family and medical providers when creating a DNR.

Similar forms

  • Living Will: A living will outlines a person's wishes regarding medical treatment in case they become unable to communicate. Like a DNR, it guides healthcare providers on what actions to take or avoid.
  • Healthcare Proxy: This document appoints someone to make medical decisions on behalf of an individual. Similar to a DNR, it ensures that a person's healthcare preferences are respected.
  • Advance Directive: An advance directive combines elements of a living will and healthcare proxy. It provides instructions for medical care and designates a decision-maker, much like a DNR does.
  • POLST (Physician Orders for Life-Sustaining Treatment): A POLST form provides specific medical orders based on a patient's preferences. It is similar to a DNR in that it communicates wishes regarding resuscitation and other treatments.
  • Do Not Intubate Order: This order specifies that a patient should not be placed on a ventilator. Like a DNR, it reflects the patient's wishes regarding life-sustaining measures.
  • Do Not Hospitalize Order: This order indicates that a patient should not be admitted to a hospital for treatment. It aligns with a DNR by prioritizing the patient's preferences for care.
  • Comfort Care Order: A comfort care order focuses on providing relief from pain and stress rather than curative treatment. This is similar to a DNR in that both prioritize the patient's comfort over aggressive medical interventions.
  • Hold Harmless Agreement: A Hold Harmless Agreement form is crucial for those engaging in risky activities, ensuring that all parties acknowledge their responsibilities. For more detailed information, visit TopTemplates.info.
  • End-of-Life Care Plan: This document outlines the care preferences for a person nearing the end of life. It shares similarities with a DNR by ensuring that the individual's wishes are honored during their final days.
  • Patient Advocate Designation: This document allows a person to choose an advocate to speak on their behalf regarding medical decisions. Like a DNR, it emphasizes the importance of respecting the patient's wishes.