Valid Do Not Resuscitate Order Template for Arizona

A Do Not Resuscitate (DNR) Order form in Arizona is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. By completing this form, a person can ensure that healthcare providers respect their decision not to undergo life-saving measures. Understanding the implications of this document is crucial for both patients and their families.

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In the state of Arizona, the Do Not Resuscitate (DNR) Order form serves as a vital document for individuals who wish to express their preferences regarding medical treatment in the event of a cardiac arrest or respiratory failure. This form allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures when they are unable to voice their wishes. Designed to respect the autonomy of patients, the DNR Order must be completed and signed by both the patient and a physician, ensuring that the decision is made with careful consideration and medical guidance. It is essential for individuals to understand the implications of this choice, as it directly impacts the care they will receive in critical situations. Furthermore, the form must be readily accessible to healthcare providers to ensure that the patient’s wishes are honored promptly and effectively. By understanding the nuances of the Arizona DNR Order form, individuals can take proactive steps to ensure their healthcare preferences are respected, fostering peace of mind for themselves and their loved ones during challenging times.

Arizona Do Not Resuscitate Order Sample

Arizona Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is executed according to Arizona state law regarding advance directives.

Patient Information:

Full Name: ____________________________
Date of Birth: _________________________
Address: ______________________________
Emergency Contact Name: _______________
Emergency Contact Phone: ______________

Healthcare Provider Information:

Provider Name: ________________________
Provider Phone: ______________________
Provider Address: _____________________

Order Statement:

I, the undersigned, hereby declare that I do not wish to receive cardiopulmonary resuscitation (CPR) or any measures to extend my life if my heart stops beating or I stop breathing.

Signature:

Patient Signature: ______________________
Date: _________________________________

If the patient is unable to sign, the signature of the healthcare representative is necessary:

Representative Name: ___________________
Relationship to Patient: ________________
Signature: ____________________________
Date: ________________________________

This document aims to clarify the patient’s wishes regarding resuscitation efforts. Ensure copies are provided to the emergency contacts and healthcare facility.

By signing this order, you affirm that your wishes are clear and understood.

Popular Do Not Resuscitate Order State Forms

Polst Form Illinois - A DNR order can alleviate guilt for family members by clarifying the patient's wishes, reducing conflicts about medical care.

To simplify the process of creating a comprehensive legal document, individuals can utilize resources such as Florida PDF Forms, which provide easily accessible templates for drafting a Florida General Power of Attorney form, ensuring that the principal's financial interests are adequately protected and managed by a trustworthy agent.

What Does Dnar Stand for - A DNR can be part of a living will or independent document specifying wishes for resuscitation.

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Key takeaways

Filling out and using the Arizona Do Not Resuscitate (DNR) Order form is an important step for individuals who wish to communicate their healthcare preferences. Here are some key takeaways to consider:

The DNR Order must be completed by a physician. This ensures that the medical professional has assessed the patient's condition and understands their wishes.
It is essential to have a conversation with family members and healthcare providers before completing the form. Open discussions can help avoid confusion and ensure everyone is on the same page.
The DNR Order should be easily accessible. Keeping a copy in a visible place, like on the refrigerator or with other important documents, can help emergency personnel locate it quickly.
Patients can revoke or change their DNR Order at any time. If your wishes change, make sure to communicate these changes to your healthcare provider and family.
In Arizona, the DNR Order is valid only if it is signed by the patient or their legal representative, along with the physician's signature. This signature confirms that the order is legitimate and reflects the patient’s wishes.
It’s important to understand that a DNR Order specifically applies to resuscitation efforts. It does not affect other medical treatments or care that a patient may receive.