Get Ks Pre-hospital Do Not Resuscitate (dnr) Request Form
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How to fill out the KS Pre-Hospital Do Not Resuscitate (DNR) Request Form online
Filling out the Kansas Pre-Hospital Do Not Resuscitate (DNR) Request Form online is a crucial step in expressing your wishes regarding emergency medical care. This guide provides clear, step-by-step instructions to help you complete the form accurately and confidently.
Follow the steps to complete the DNR request form online.
- Click the ‘Get Form’ button to access the DNR request form and open it in your preferred editing tool.
- In the first field, enter your full name where it states, 'I, ___________________, request limited emergency care as herein described.' This is necessary to identify you as the individual requesting the DNR.
- Review the statement that explains the meaning of DNR. This confirms that should your heart stop or you stop breathing, no procedures will be initiated to restart them. Ensure you understand this before proceeding.
- Read the subsequent statements carefully, which clarify that this choice does not limit your access to other emergency medical assistance. Acknowledge that you may revoke this directive at any time.
- Provide your signature at the designated line, affirming your agreement to the DNR directive. This signature represents your consent.
- Enter the date of signing next to your signature to provide a timeline for this directive.
- A witness signature is also required. Find an impartial person who can sign the form as a witness, and have them write their signature and the date in the appropriate fields.
- The final step includes the signature of the attending physician, if applicable. If you belong to a religious organization that allows spiritual treatment, physician signature may not be needed. If needed, have them sign and date the form and fill in their address and facility name.
- If you wish to revoke the DNR directive, complete the revocation provision section by signing, dating, and providing your information.
- After filling out all necessary sections, you can save your changes, download the completed form, print it for your records, or share it with relevant healthcare providers.
Complete your KS Pre-Hospital Do Not Resuscitate (DNR) Request Form online today to ensure your healthcare wishes are respected.
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To place yourself on a do not resuscitate status, you need to complete the KS Pre-Hospital Do Not Resuscitate (DNR) Request Form. It's essential to have a conversation with your healthcare provider about your health condition and end-of-life care preferences. Once you fill out and sign the form, distribute it to your medical team and keep a copy accessible. This formalizes your choice and ensures it is respected in medical emergencies.
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