Get Out-of-hospital Do-not-resuscitate - University Health System

Filling out the Out-of-hospital Do-not-resuscitate (OOH-DNR) Order is a critical process for individuals wanting to ensure their preferences regarding resuscitation are respected in out-of-hospital settings. This guide provides a clear and comprehensive overview of how to accurately complete the form online for your peace of mind and in alignment with your health care wishes.

Follow the steps to fill out the Out-of-hospital Do-not-resuscitate Order correctly.

1. Click the ‘Get Form’ button to access the OOH-DNR Order form and open it in your editing application.
2. Begin by filling in your personal information, including your full legal name, date of birth, and gender. This information is crucial for identifying you as the declarant.
3. In Section A, declare your competency by confirming that you are at least 18 years old and able to make your own decisions. Indicate your direction regarding resuscitation measures by signing and dating the document.
4. If you are unable to communicate or are represented by a guardian or proxy, complete Section B. The designated representative must sign and date this section, confirming their authority to act on your behalf.
5. For individuals without a legal guardian or proxy, a qualified relative may complete Section C. The relative must sign and date this section, asserting their relationship and authority to make decisions for you.
6. In Section D, should you be unable to communicate and have a directive in place, your attending physician can execute the order by signing and dating this section, — ensure evidence of your previous directive is documented.
7. If the person is a minor, their parent or legal guardian must complete Section E by signing and dating the form as directed.
8. Section F enables two attending physicians to sign in scenarios where the person's wishes are not known. Both physicians must document their concurrence regarding the necessity of the OOH-DNR Order.
9. Ensure that two competent adults serve as witnesses, signing in the designated area to validate the process. Their signatures should reflect that they have witnessed the execution of the form.
10. After completing all relevant sections, review the document for accuracy. You can then save changes, download, print, or share the completed form as needed.

Complete your Out-of-hospital Do-not-resuscitate Order online to ensure your health care preferences are honored.