Valid Do Not Resuscitate Order Template for Washington

A Washington Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to refuse cardiopulmonary resuscitation (CPR) in the event of a medical emergency. This form is crucial for those who wish to ensure their healthcare preferences are respected when they cannot communicate. Understanding how to complete and implement this form can provide peace of mind for patients and their families.

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In the state of Washington, the Do Not Resuscitate (DNR) Order form plays a crucial role in ensuring that individuals' healthcare preferences are honored during critical medical situations. This form is particularly important for patients who wish to forgo resuscitation efforts, such as cardiopulmonary resuscitation (CPR), in the event of cardiac or respiratory arrest. It is designed to provide clear instructions to medical professionals, ensuring that a patient's wishes regarding life-sustaining treatments are respected. The DNR Order must be completed and signed by a qualified healthcare provider, reflecting a thorough discussion with the patient or their legal representative about the implications of such a decision. Additionally, the form includes specific details, such as the patient's name, date of birth, and the signature of the healthcare provider, which helps to validate the document. By understanding the nuances of the DNR Order, individuals can make informed decisions about their end-of-life care, emphasizing the importance of communication and planning in advance of medical emergencies.

Washington Do Not Resuscitate Order Sample

Washington Do Not Resuscitate (DNR) Order

This Do Not Resuscitate (DNR) Order is made in accordance with the laws of the State of Washington. It reflects the wishes of the individual regarding medical treatment in the event of cardiac arrest or respiratory failure.

Please fill in the information below:

Patient's Full Name: _____________________________
Date of Birth: _________________________________
Patient's Address: _____________________________
City: ________________________________
State: ________________________________
Zip Code: ________________________________
Patient's Healthcare Provider: _____________________________
Provider's Contact Number: _________________________

Emergency Contact:

Name: ______________________________________
Relationship to Patient: _______________________
Contact Number: _____________________________

This section must be completed by the patient (or their medical decision-maker) and healthcare provider:

Signature of Patient or Legal Representative: ________________________
Date: ________________________
Signature of Healthcare Provider: _________________________
Date: ________________________

By signing this DNR Order, you acknowledge that you understand the implications of this decision. Ensure that copies of this document are provided to your healthcare provider and kept in accessible locations.

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Key takeaways

When considering a Do Not Resuscitate (DNR) Order in Washington, it is essential to understand the following key points:

The DNR Order must be signed by a physician, ensuring that it is valid and recognized by medical personnel.
Patients or their legal representatives should discuss their wishes regarding resuscitation with healthcare providers before completing the form.
The form should be easily accessible, ideally kept with other important medical documents or in a visible location at home.
It is important to regularly review and update the DNR Order as circumstances or health conditions change.
Healthcare providers are required to honor the DNR Order as long as it is properly completed and signed.