Get Do Not Intubate Form - Lincoln Ne

Filling out the Do Not Intubate Form in Lincoln Ne is a crucial step for individuals who wish to express their medical care preferences. This guide provides clear instructions to help users complete the form effectively and understand its implications.

Follow the steps to fill out the Do Not Intubate Form accurately.

1. Click ‘Get Form’ button to retrieve the Do Not Intubate Form and open it in your document editor.
2. In the first section, you will see a space to fill in your name. Clearly print your full legal name as it should appear on official documents.
3. Next, acknowledge your medical condition by stating the diagnosis as discussed with your physician. This information validates your request for a Do Not Intubate order.
4. You must check the box labeled ‘DO NOT INTUBATE’ to indicate that you do not wish for any artificial means of breathing assistance to be used under specified circumstances.
5. Next, if you also wish to include a Do Not Resuscitate order, check the ‘DO NOT RESUSCITATE (DNR)’ box. This signifies that you do not want resuscitation efforts in the event of a cardiac or respiratory arrest.
6. Proceed to sign the form in the designated area, ensuring that the signature is from you, your next of kin, or your durable power of attorney for health care. Be sure to date your signature.
7. Provide your address in the next section, including the name of the facility if you are currently in one.
8. A witness is required to sign the form, affirming that the document is legitimate and reflects your wishes.
9. The physician will need to fill in their printed name, date of birth, and sign the form, confirming that they have discussed your medical condition and treatment with you.
10. Lastly, if the DNR order was made by telephone, check the appropriate box and ensure that an agency representative signs off on the document.
11. Once all fields are completed, you can save changes, download the completed form, or print it for your records. Ensure copies are distributed as indicated.

Begin filling out your Do Not Intubate Form online today to ensure your medical preferences are documented.