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.
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
A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.
DNR stands for Do Not Resuscitate and tells health care providers and emergency medical personnel not to do CPR on your older adult if they stop breathing or if their heart stops beating. The DNR is only a decision about CPR (cardiopulmonary resuscitation).
Use a form provided by your doctor. Write your wishes down by yourself. Call your health department or state department on aging to get a form. Call a lawyer. Use a computer software package for legal documents.
DNRs are usually signed in a hospital or nursing home when you are diagnosed with a terminal illness. It does not have to be drafted by an elder law attorney, but it is a good idea to consult with one to get all the information necessary when deciding if you need a DNR.
Include your name, DNR status, where to access your written DNR Order, and an emergency contact number on your DNR tag. Provide your emergency contact with a copy of your DNR Order and your doctor's phone number.
A do-not-resuscitate (DNR) order placed in a person's medical record by a doctor informs the medical staff that cardiopulmonary resuscitation (CPR) should not be attempted.
New York's 11 public hospitals are at the forefront of a national movement to standardize color coding of hospital wristbands to designate patient conditions, in which purple the color of amethyst means Do Not Resuscitate, or DNR.
Changing a POLST form or removing a DNR bracelet is fairly straightforward and free.Twelve states, including California and New York, recognize the POLST form as legally binding orders to forego CPR and other resuscitation measures.
Discuss the particulars of your DNR jewelry with your doctor. Have it custom engraved just for you. Include your name, DNR status, where to access your written DNR Order, and an emergency contact number on your DNR tag.
