Indiana Do Not Resuscitate Form Format

State:
Indiana
Control #:
IN-P022B
Format:
Word; 
Rich Text
Instant download

Description

The Indiana Do Not Resuscitate Form Format is designed for individuals who wish to indicate their preference regarding resuscitation efforts in emergency situations outside of hospital settings. This form allows users to formally revoke a previously issued Do Not Resuscitate Declaration and Physician's Do Not Resuscitate Order. Key features include a clear declaration statement, space for the declarant's signature, printed name, and address, as well as confirmation of the date of revocation. Filling out the form requires the declarant to provide personal information and may necessitate the involvement of witnesses, ensuring that the document is legally binding. The form is particularly useful for attorneys, partners, owners, associates, paralegals, and legal assistants who guide clients through end-of-life planning and ensure patients' wishes are respected in healthcare settings. This form supports individuals in making informed decisions regarding their medical care by clearly outlining their preferences, alleviating potential confusion for healthcare providers at critical moments.

How to fill out Indiana Revocation Of Out Of Hospital - Do Not Resuscitate Declaration - DNR?

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FAQ

A DNR order must be written by a doctor. The doctor will typically explain your options to you and your family, outlining what the DNR entails. With your consent, the doctor will create the order and enter it into your medical record. It will then be visible and applicable to any medical professionals who treat you.

The Indiana POST form must include the following to be valid: Patient name; code status order; treating practitioner signature with date; and patient or legal representative signature with date. The form must also be in English.

The patient's physician must approve of a DNR, confirming the patient's condition by signing the DNR form. Aside from the patient's and physician's signatures, two (2) witnesses are required to make a DNR order valid. Required to Sign ? Patient, physician and two (2) witnesses.

Creating a DNR is simple and affordable at 12 Law. The only person that you need it signed with is your doctor and the presence of an adult witnesses or a lawyer who will witness for you as you sign the document.

I, _________________________________________, request limited emergency care as herein described. I understand DNR means that if my heart stops beating or if I stop breathing, no medical procedure to restart breathing or heart functioning will be instituted.

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Indiana Do Not Resuscitate Form Format