This is a form initiated by a patient requesting that he/she not be resuscitated should he/she stop breathing or should his/her heart stop beating. This form is also to be signed by a physician attesting to patient's wishes and to be placed in the patient's file.
Minnesota Do Not Resuscitate Request - DNR
State:
Multi-State
Control #:
US-PRM-12
Format:
Word;
Rich Text
Instant download
Description
How to fill out Do Not Resuscitate Request - DNR?
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FAQ
DNR protocols typically require the signing of an out-of-hospital DNR order by both the physician and patient (or the patient's surrogate) and the use of a special identifier (eg, a bracelet or brightly colored form) that is worn by or kept near the patient.
Mndnr.gov/mobile/compass Use the Rec Compass app to find information about state and federal recreation facilities in Minnesota. The Recreation Compass map employs different layers such as lakes, forests, parks, and trails. Search by name or by map.
The most important factor to bear in mind is that the law does not require a patient, or their family to consent to a DNR order. This means a doctor can issue a DNR order, even if you do not want one (see section on what to do if there is a disagreement).
You decide deciding in advance to refuse CPR You can make it clear to your doctor or medical team that you do not want CPR if your heart or breathing stops. Your doctor may complete a DNACPR form to indicate this and put it in your medical records.
Information Center: 888-646-6367 To reach a conservation officer.
The DNR Customer Service Center can be reached by phone at 317-232-4200 or 877-463-6367 or by email at CSCinquiry@dnr.IN.gov, a.m. - 4 p.m. Monday through Friday.
When You are Unable to Make the Decision You may have named someone to speak for you, such as a health care agent. If so, this person or a legal guardian can agree to a DNR order for you.
DNR license center (St. Licensing, registration and titling service in-person hours: 8 a.m. to p.m., Monday-Friday. Licenses may be purchased anytime by phone at 888-665-4236 or online.
The mission of the Minnesota Department of Natural Resources (DNR) is to work with Minnesotans to conserve and manage the state's natural resources, to provide outdoor recreation opportunities, and to provide for commercial uses of natural resources in a way that creates a sustainable quality of life.
Do not resuscitate order A DNR is a request not to have CPR if your heart stops or if you stop breathing. You can use an advance directive form or tell your doctor that you don't want to be resuscitated. Your doctor will put the DNR order in your medical chart. Doctors and hospitals in all states accept DNR orders.
