Do Not Resuscitate Request - DNR
Overview of this form
The Do Not Resuscitate Request (DNR) is a legal document that allows a patient to express their wishes concerning medical treatment in the event of cardiac or respiratory arrest. The primary purpose of this form is to inform healthcare providers that the patient does not wish to be resuscitated if their heart stops beating or they stop breathing. This directive is distinct from other advance directives, such as living wills, as it specifically addresses the refusal of resuscitation efforts.
Key components of this form
- Patient/surrogate signature: Indicates the individual's agreement to the DNR order.
- Physician's signature: Confirms that the physician has verified and supports the patient's wishes.
- Revocation clause: Allows the patient to revoke the DNR order at any time by destroying the form.
- Emergency personnel notification: Grants permission for the form to be shared with emergency care personnel.
- Instructions for treatment: Clearly states that no resuscitation efforts are to be performed in case of cardiac or respiratory arrest.
Situations where this form applies
This form should be used when a patient wishes to prevent resuscitation in case of certain medical emergencies, such as cardiac arrest or failure to breathe. It is particularly relevant for individuals with terminal illnesses, severe chronic conditions, or those undergoing significant decline in health. Discussing the DNR request with healthcare professionals and family members beforehand is advisable to ensure everyone understands and respects the patient's wishes.
Who should use this form
- Patients with terminal illnesses who wish to avoid aggressive resuscitation measures.
- Individuals experiencing significant health decline and want to express their end-of-life preferences.
- Surrogates or family members acting on behalf of incapacitated patients who want to communicate a DNR request.
- Anyone seeking to have clear medical directives documented for emergency situations.
Steps to complete this form
- Identify the patient: Clearly write the full name of the patient requesting the DNR.
- Sign the form: The patient or authorized surrogate must sign and date the document.
- Obtain physician's approval: Have the physician review the request and sign the form.
- Distribute copies: Make several copies of the signed form for the patient's medical record and for emergency care personnel.
- Keep the original accessible: Ensure the original form is easily accessible, especially in emergency situations.
Does this document require notarization?
In most cases, this form does not require notarization. However, some jurisdictions or signing circumstances might. US Legal Forms offers online notarization powered by Notarize, accessible 24/7 for a quick, remote process.
Get your form ready online
Our built-in tools help you complete, sign, share, and store your documents in one place.
Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Common mistakes to avoid
- Failing to have the physician sign the form which can render it invalid.
- Not discussing the wishes with family members, leading to confusion in emergency situations.
- Not keeping copies of the signed form accessible for emergency personnel.
- Signing the form without fully understanding the implications of a DNR request.
Advantages of online completion
- Convenience: Access and fill out the form from home at any time.
- Editability: Easily make changes as necessary to reflect current wishes.
- Reliability: Obtain legal forms drafted by licensed attorneys, ensuring compliance with local laws.
Summary of main points
- The DNR form allows patients to specify their wishes regarding resuscitation.
- It requires signatures from both the patient (or surrogate) and a physician.
- This form should be easily accessible by medical personnel at critical times.
Looking for another form?
Form popularity
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.
