Valid Do Not Resuscitate Order Template for Delaware

Valid Do Not Resuscitate Order Template for Delaware

A Delaware Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding medical treatment in case of a life-threatening situation. By completing this form, you can ensure that healthcare providers respect your decision not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures. Understanding how to properly use this form is essential for anyone considering their end-of-life care options.

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In Delaware, the Do Not Resuscitate (DNR) Order form is a critical document that allows individuals to express their wishes regarding medical treatment in the event of a cardiac arrest or respiratory failure. This form serves as a legal directive for healthcare providers, ensuring that a patient's preferences regarding resuscitation efforts are respected. It is important for individuals to understand the implications of signing a DNR order, as it indicates a desire to forego life-saving measures such as CPR or advanced cardiac life support. The DNR form must be completed and signed by a qualified healthcare professional, and it requires the patient’s or their legal representative's consent. Moreover, this document should be readily accessible to medical personnel, often stored in a visible location or included in the patient’s medical records. Understanding the nuances of the DNR order can empower individuals to make informed decisions about their healthcare and end-of-life preferences.

Delaware Do Not Resuscitate Order Sample

Delaware Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order (DNR) is created in compliance with Delaware law, specifically under 16 Del. C. Chapter 2503. It is designed for individuals who wish to decline resuscitation efforts in the event that their heart stops beating or they stop breathing.

Please fill out this form completely, ensuring that the information is accurate and up-to-date.

Patient Information:

  • Name: ____________________________
  • Date of Birth: ____________________
  • Address: __________________________
  • Phone Number: ____________________

Physician Information:

  • Physician Name: ____________________________
  • Physician Phone Number: ____________________
  • Physician Address: __________________________

Patient’s Wishes:

I, the undersigned, declare that I do not wish to receive any resuscitative measures such as CPR, intubation, or cardiac paddles in case of cardiac arrest or respiratory failure.

Signature of Patient or Authorized Representative: ___________________

Date: _______________

Witness Information:

  • Witness Name: ______________________________
  • Witness Address: ___________________________
  • Witness Signature: __________________________
  • Date: _____________________

This DNR Order is valid until revoked or updated in writing. It is strongly advised to keep a copy of this order on hand and inform all relevant healthcare providers of its existence.

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Key takeaways

When considering the Delaware Do Not Resuscitate (DNR) Order form, it is essential to understand its significance and the proper steps to complete it. Here are some key takeaways:

  1. The DNR Order is a legal document that indicates a person's wishes regarding resuscitation efforts in the event of a medical emergency.
  2. It is crucial for individuals to discuss their wishes with family members and healthcare providers before filling out the form.
  3. The form must be signed by the individual (or their legal representative) and a physician to be valid.
  4. Once completed, the DNR Order should be kept in an easily accessible location, such as a medical file or with a caregiver.
  5. Healthcare providers are required to honor a valid DNR Order, so it is important to ensure that the form is clear and properly executed.
  6. Individuals can revoke the DNR Order at any time, but they must communicate this decision clearly to their healthcare team.
  7. The DNR Order applies only to resuscitation efforts and does not affect other medical treatments or interventions.
  8. In Delaware, the DNR Order can also be registered with the state’s health department for additional recognition.
  9. It is advisable to review the DNR Order regularly, especially if there are changes in health status or personal wishes.
  10. Having a DNR Order can provide peace of mind for both individuals and their families during difficult times.

Understanding these key points can help ensure that the DNR Order reflects the individual’s wishes and is respected by healthcare professionals.