Free Do Not Resuscitate Order Form for the State of Pennsylvania

1. Failing to provide the patient's full name. Accurate identification is crucial for the validity of the order.

2. Not including the date of the order. Omitting this information can lead to confusion about when the order was established.

3. Using unclear language or abbreviations. It is essential to use straightforward language to avoid misinterpretation of the patient's wishes.

4. Neglecting to sign the form. Without a signature, the order cannot be considered legally binding.

5. Not having a witness present when signing. A witness can help confirm the authenticity of the order.

6. Forgetting to provide contact information for the healthcare representative. This information is vital for healthcare providers to reach the designated individual.

7. Overlooking the need for periodic reviews of the order. Patients' wishes may change over time, and the order should reflect current preferences.

8. Failing to distribute copies of the signed order. It is important to share the document with healthcare providers and family members to ensure everyone is informed.

• Living Will: A living will outlines a person's wishes regarding medical treatment in situations where they cannot communicate. Like a Do Not Resuscitate Order, it guides healthcare providers about what actions to take or avoid in critical situations.

• Homeschool Letter of Intent: This document is required by parents to officially inform the state about their decision to homeschool their children, ensuring compliance with educational regulations. For more information, visit https://azformsonline.com/homeschool-letter-of-intent/.

• Healthcare Power of Attorney: This document allows someone to make medical decisions on behalf of another person if they become incapacitated. Similar to a DNR, it ensures that a person's healthcare preferences are respected, particularly in emergencies.
• Advance Healthcare Directive: An advance healthcare directive combines elements of a living will and a healthcare power of attorney. It not only states a person's wishes for medical treatment but also appoints someone to make decisions, similar to how a DNR specifies preferences for resuscitation.
• Physician Orders for Life-Sustaining Treatment (POLST): A POLST form translates a patient’s wishes regarding life-sustaining treatments into actionable medical orders. Like a DNR, it communicates specific instructions to healthcare providers about the level of care desired in emergencies.

When filling out the Pennsylvania Do Not Resuscitate Order form, it is important to follow certain guidelines to ensure that your wishes are clearly communicated. Here are some dos and don'ts to keep in mind:

• Do read the entire form carefully before starting to fill it out.
• Do consult with your healthcare provider to discuss your wishes.
• Do ensure that the form is signed and dated by you or your authorized representative.
• Do keep a copy of the completed form for your records.
• Don't use the form if you are not sure about your decision.
• Don't forget to inform your family members about your DNR order.
• Don't leave any sections of the form blank; complete all required fields.
• Don't assume that verbal instructions are enough; always have a written order.

By following these guidelines, you can help ensure that your preferences regarding resuscitation are respected and understood by your healthcare team.

• Misconception 1: A Do Not Resuscitate (DNR) order means that no medical treatment will be provided.

This is incorrect. A DNR order specifically addresses resuscitation efforts in the event of cardiac arrest. Other medical treatments and interventions can still be provided as needed.

• Misconception 2: DNR orders are only for terminally ill patients.

While many people associate DNR orders with terminal illness, anyone can request one, regardless of their health status. It is a personal choice based on individual values and preferences.

• Misconception 3: A DNR order is permanent and cannot be changed.

This is false. A DNR order can be revoked or modified at any time by the patient or their authorized representative. It is important to communicate any changes to healthcare providers.

• Misconception 4: DNR orders are only valid in hospitals.

DNR orders can be valid in various settings, including at home or in long-term care facilities. However, it is crucial to ensure that the order is properly documented and recognized by healthcare providers in those settings.

• Misconception 5: A DNR order means healthcare providers will not provide comfort care.

This is not true. A DNR order does not affect the provision of comfort care, such as pain management and palliative care. Patients can still receive compassionate treatment to ensure their comfort.

• Misconception 6: DNR orders are the same as living wills.

While both documents are related to end-of-life decisions, they serve different purposes. A living will outlines a person's wishes regarding medical treatment in general, while a DNR specifically addresses resuscitation efforts.