Attorney-Verified Do Not Resuscitate Order Template

Attorney-Verified Do Not Resuscitate Order Template

A Do Not Resuscitate (DNR) Order is a legal document that allows individuals to express their wishes regarding medical treatment in the event of a cardiac or respiratory arrest. This form ensures that medical personnel understand a patient's desire to forgo life-saving measures. Understanding the implications of a DNR Order can empower individuals to make informed decisions about their healthcare preferences.

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The Do Not Resuscitate Order (DNR) form is a critical document that reflects an individual’s wishes regarding medical treatment in the event of a cardiac arrest or respiratory failure. This form serves as a directive for healthcare providers, indicating that the patient does not wish to receive cardiopulmonary resuscitation (CPR) or other life-saving measures. It is essential for patients and their families to understand that a DNR order is not a denial of care; rather, it is a choice to focus on comfort and quality of life when faced with terminal conditions. The form typically requires the signature of both the patient and a physician, ensuring that the decision is informed and voluntary. Additionally, it is important to discuss the implications of a DNR order with loved ones and healthcare professionals, as this can facilitate clear communication about end-of-life preferences. Understanding the nuances of the DNR form can empower individuals to make informed choices that align with their values and wishes.

Do Not Resuscitate Order Sample

Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is in accordance with the laws of [State Name], specifically adhering to the relevant statutes and regulations regarding end-of-life decisions.

Patient Information:

  • Name: ___________________________
  • Date of Birth: ______________________
  • Address: ___________________________
  • Emergency Contact: ________________________
  • Phone Number: ________________________

Physician Information:

  • Name: ___________________________
  • Medical License Number: ________________
  • Phone Number: ________________________

Patient's Medical Condition:

______________________________________________________

______________________________________________________

Statement of Wishes:

By signing this document, I, the undersigned patient, declare that I do not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest or respiratory failure.

Signature:

_____________________ (Patient's Signature)

Date: ________________

Witness Information:

  • Name: ___________________________
  • Signature: _______________________
  • Date: _________________________

This document serves as a legal directive and must be provided to medical personnel and included in the patient's medical record.

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Key takeaways

Filling out a Do Not Resuscitate (DNR) Order form is an important decision that requires careful consideration. Here are some key takeaways to keep in mind:

  • Understand the Purpose: A DNR order communicates your wishes regarding resuscitation efforts in the event of a medical emergency. It ensures that your preferences are honored when you are unable to speak for yourself.
  • Consult with Healthcare Professionals: Before completing the form, discuss your choices with your doctor or healthcare provider. They can provide guidance on the implications of a DNR order and help you make an informed decision.
  • Ensure Proper Documentation: Once the form is filled out, it must be signed and dated by both you and your physician. Keep copies in accessible locations, such as with your medical records and at home.
  • Review and Update Regularly: Your health status and preferences may change over time. Regularly reviewing your DNR order ensures that it reflects your current wishes and circumstances.