Advance Directive Form Template For Patients

Category:
State:
Multi-State
Control #:
US-02091BG
Format:
Word; 
Rich Text
Instant download

Description

A do not resuscitate (DNR) order is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing. A DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states.


This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.

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How to fill out Do Not Resuscitate Order - DNR Or Advance Directive?

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FAQ

Talk about your values ? what makes your life worth living and what you consider quality of life. Approach the conversation wanting to share your wishes before you ask someone else to share their own wishes. Be prepared to have more than one conversation or that the subject may cause an emotional reaction. This is ok.

______ I appoint this person to make decisions about my medical care if there ever comes a time when I cannot make those decisions myself. I want the person I have appointed, my doctors, my family and others to be guided by the decisions I have made in the parts of the form that follow.

The most common statement in a living will is to the effect that: If I suffer an incurable, irreversible illness, disease, or condition and my attending physician determines that my condition is terminal, I direct that life-sustaining measures that would serve only to prolong my dying be withheld or discontinued.

The two most common advance directives for health care are the living will and the durable power of attorney for health care. Living will: A living will is a legal document that tells doctors how you want to be treated if you cannot make your own decisions about emergency treatment.

I direct that I be given health care treatment to relieve pain or provide comfort even if such treatment might shorten my life, suppress my appetite or my breathing, or be habit forming. 2. I direct that all life prolonging procedures be withheld or withdrawn.

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Advance Directive Form Template For Patients