Homepage >> Fillable Do Not Resuscitate Order Template

Common mistakes

  1. Not discussing with a healthcare provider: Many individuals neglect to have a conversation with their doctor about their wishes. This can lead to misunderstandings about what a Do Not Resuscitate (DNR) order truly entails.

  2. Failing to involve family members: It's crucial to include loved ones in the decision-making process. Without their input, there may be confusion or conflict when the time comes to enforce the DNR order.

  3. Leaving sections blank: Some people mistakenly skip over parts of the form, believing that it will still be valid. Incomplete forms can create complications and may not be honored by medical personnel.

  4. Not signing or dating the form: A DNR order must be signed and dated to be legally binding. Omitting this step can render the document ineffective.

  5. Using outdated forms: Medical regulations can change, and using an old version of the DNR form might lead to issues. Always ensure that you have the most current document.

  6. Not keeping copies accessible: After completing the DNR order, it's vital to keep copies in easily accessible locations. If the form is not readily available, medical personnel may not be aware of your wishes.

  7. Ignoring state-specific requirements: Each state may have different laws regarding DNR orders. Failing to comply with these regulations can invalidate your wishes.

  8. Not reviewing the order periodically: Life circumstances change, and so may your preferences. Regularly reviewing your DNR order ensures it still aligns with your current wishes.

  9. Assuming verbal agreements are enough: Relying solely on verbal discussions without formal documentation can lead to misunderstandings. A written order is essential for clarity and legal standing.

  10. Overlooking the need for witnesses: Some states require witnesses to the signing of a DNR order. Not adhering to this requirement can lead to complications when the order is needed.

Similar forms

A Do Not Resuscitate (DNR) Order form is an important document that expresses a person's wishes regarding medical treatment in the event of a life-threatening situation. Several other documents serve similar purposes, providing guidance on healthcare decisions. Here are six documents that are comparable to a DNR Order:

  • Advance Healthcare Directive: This document outlines a person's preferences for medical treatment and appoints a healthcare proxy to make decisions if they become unable to communicate their wishes.
  • Living Will: A living will specifically details the types of medical treatments a person does or does not want in situations where they cannot express their wishes, particularly at the end of life.
  • Trailer Bill of Sale: This document is essential for transferring ownership of a trailer and can be obtained from NC PDF Forms, ensuring all necessary details about the trailer are accurately recorded.
  • Healthcare Power of Attorney: This legal document designates someone to make healthcare decisions on behalf of an individual if they are incapacitated, ensuring that their wishes are honored.
  • Physician Orders for Life-Sustaining Treatment (POLST): A POLST form translates a patient’s preferences for treatment into actionable medical orders, guiding healthcare providers in emergency situations.
  • Do Not Intubate (DNI) Order: Similar to a DNR, a DNI order specifically states that a person does not wish to be intubated or placed on a ventilator in case of respiratory failure.
  • Organ Donation Consent: This document expresses a person's wishes regarding organ donation after death, ensuring that their intentions are clear and respected by healthcare providers.

Understanding these documents can help individuals make informed decisions about their healthcare preferences. It's essential to discuss these options with loved ones and healthcare providers to ensure that everyone is aware of your wishes.

Dos and Don'ts

When filling out a Do Not Resuscitate (DNR) Order form, it is essential to approach the process with care and consideration. Here are some important guidelines to follow and avoid.

  • Do ensure clarity: Write legibly to avoid any misunderstandings regarding your wishes.
  • Do discuss with your healthcare provider: Have a conversation about your medical condition and the implications of a DNR order.
  • Do involve your family: Make sure your loved ones understand your decision and support it.
  • Do keep the form accessible: Store the DNR order in a place where it can be easily found by medical personnel.
  • Do review regularly: Reassess your wishes periodically, especially after significant health changes.
  • Don't rush the decision: Take your time to think about your options and what is best for you.
  • Don't assume everyone knows your wishes: Communicate your decision clearly to family members and caregivers.
  • Don't forget to sign: Ensure that the form is properly signed and dated to make it valid.
  • Don't ignore state laws: Familiarize yourself with your state’s requirements for DNR orders, as they can vary.

By following these guidelines, you can ensure that your DNR order accurately reflects your wishes and is respected in a medical situation. It’s a significant decision, and taking the time to do it right can provide peace of mind for you and your loved ones.

Preview - Do Not Resuscitate Order Form

Do Not Resuscitate Order (DNR) Template

This Do Not Resuscitate Order is based on the laws of [State] and is intended to express the wishes of the patient regarding resuscitation efforts in the event of cardiac arrest or respiratory failure.

Patient Information

  • Patient's Full Name: ___________________________
  • Date of Birth: ___________________________
  • Address: ___________________________
  • Phone Number: ___________________________

Medical Declaration

I, the undersigned, hereby declare my wishes regarding medical care during a terminal illness or irreversible condition. I understand that this order means that if my heart stops or I stop breathing, I do not want any resuscitation methods used to revive me.

Patient Signature

  • Signature: ___________________________
  • Date: ___________________________

Witness Information

The following individuals have witnessed my signature and affirm that I am of sound mind and not under duress:

  1. Witness 1 Name: ___________________________
  2. Witness 1 Signature: ___________________________
  3. Date: ___________________________
  1. Witness 2 Name: ___________________________
  2. Witness 2 Signature: ___________________________
  3. Date: ___________________________

Healthcare Provider's Acknowledgment

This order should be honored by all healthcare providers. I affirm that I have reviewed and understand this Do Not Resuscitate Order with the patient.

  • Healthcare Provider's Name: ___________________________
  • Healthcare Provider's Signature: ___________________________
  • Date: ___________________________

This Do Not Resuscitate Order is valid as per the laws of [State]. It is recommended that copies of this order be provided to all relevant parties, including family members and healthcare providers.

Misconceptions

Understanding the Do Not Resuscitate (DNR) Order form is crucial for both patients and healthcare providers. Unfortunately, several misconceptions can cloud the true purpose and implications of this important document. Here are eight common misconceptions:

  1. A DNR means I won't receive any medical treatment. Many believe that having a DNR in place means they will not receive any medical care. In reality, a DNR specifically addresses resuscitation efforts during cardiac or respiratory arrest, not other forms of medical treatment.
  2. DNR orders are only for terminally ill patients. This is a widespread belief, but DNR orders can be appropriate for anyone who wishes to avoid resuscitation, regardless of their overall health status or prognosis.
  3. If I have a DNR, I will be left to die. A DNR does not mean that healthcare providers will abandon a patient. It simply indicates a preference against aggressive resuscitation measures in certain situations.
  4. A DNR is permanent and cannot be changed. Many think that once a DNR is established, it cannot be altered. In fact, patients can change their DNR status at any time, reflecting their current wishes.
  5. Having a DNR means I cannot have a living will. Some individuals believe that a DNR and a living will are mutually exclusive. However, both documents can coexist and serve complementary purposes in expressing a patient’s healthcare preferences.
  6. All healthcare providers understand my DNR wishes. While DNR orders are legally binding, not all healthcare providers may be familiar with a patient’s specific wishes. It is essential to communicate openly with all members of the healthcare team.
  7. DNR orders are only for hospitals. Many people think DNR orders apply only within hospital settings. In reality, DNR orders can be established for various care settings, including home care and hospice.
  8. Once signed, a DNR is automatically honored. Although DNR orders are meant to be respected, there may be instances where additional verification or discussion is necessary, especially in emergency situations.

Addressing these misconceptions can help ensure that patients’ wishes are understood and respected, leading to better healthcare experiences and outcomes.

How to Use Do Not Resuscitate Order

Filling out a Do Not Resuscitate (DNR) Order form is a personal decision that requires careful consideration. After completing the form, it will be important to ensure that it is shared with your healthcare provider and kept in a location where it can be easily accessed in case of a medical emergency.

  1. Obtain the DNR Order form from a healthcare provider, hospital, or online resource.
  2. Read the instructions provided with the form to understand the requirements.
  3. Fill in your full name, date of birth, and other identifying information as requested.
  4. Indicate your wishes regarding resuscitation by checking the appropriate box or providing a signature as required.
  5. Include the date on which you are signing the form.
  6. Sign the form to validate your wishes. Some forms may require a witness signature or notarization.
  7. Make copies of the completed form for your records and to share with your healthcare provider.
  8. Discuss your DNR Order with family members and caregivers to ensure they understand your wishes.