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Addressograph Do Not Resuscitate or Limited Resuscitation Physician Orders (Adult Only) HT: cm WT: kg ALLERGIES: PHYSICIAN ORDERS PROGRESS RECORD These orders should NOT be used for patients with

How to fill out do not resuscitate or

How to fill out a do not resuscitate order:

1. Consult with a healthcare professional: Before filling out a do not resuscitate (DNR) order, it is important to talk to a healthcare professional, such as your doctor or nurse, who can provide you with the necessary information and guide you through the process.
2. Understand the purpose of a DNR: A DNR order is a legal document that indicates your preference to withhold cardiopulmonary resuscitation (CPR) in case your heart stops or you stop breathing. It is designed for individuals who have a terminal illness or do not wish to receive life-saving measures.
3. Obtain the appropriate form: Each state or country may have its own specific DNR form or document. You can obtain the form from your healthcare provider, hospital, or your local health department. It is essential to ensure you have the correct form that complies with the laws and regulations of your jurisdiction.
4. Fill out personal information: The DNR form will typically require you to provide your personal information, including your full legal name, date of birth, address, and contact information. Make sure all the information is accurate and up to date.
5. Discuss your preferences: You may have the option to indicate your specific preferences regarding resuscitation measures. Some forms allow you to choose between full resuscitation, limited resuscitation, or comfort care only. Discuss these options with your healthcare professional and select the option that aligns with your wishes.
6. Sign the form: Once you have completed filling out the DNR form, it is essential to sign and date it. Some forms may require the presence of witnesses or a notary public during the signing process. Follow the instructions on the form carefully to ensure its validity.
7. Distribute copies: It is important to distribute copies of the signed DNR form to appropriate individuals or organizations. This may include your healthcare provider, hospital, family members, or caregivers. Keep a copy of the form easily accessible at home as well.

Who needs a do not resuscitate order?

1. Terminally ill individuals: DNR orders are often considered by individuals who have been diagnosed with a terminal illness and wish to avoid aggressive life-saving measures towards the end of their life. It allows them to have a peaceful, natural death without undergoing resuscitation.
2. Those with chronic illnesses: Some individuals with chronic illnesses, such as advanced stages of cancer, severe heart disease, or chronic obstructive pulmonary disease (COPD), may also consider a DNR order as part of their advance care planning.
3. Elderly individuals: As individuals age, they may face increasing health challenges and the possibility of life-threatening medical emergencies. Some elderly individuals may choose to have a DNR order in place to ensure their end-of-life wishes are respected.

Remember, the decision to have a DNR order is deeply personal and should be discussed with healthcare professionals, loved ones, and possibly a legal professional to ensure it aligns with your individual circumstances and values.

For pdfFiller’s FAQs

What is do not resuscitate or?

Do not resuscitate, or DNR, is a legal order written by a physician instructing healthcare providers not to attempt CPR or other life-saving measures in case of cardiac or respiratory arrest.

Who is required to file do not resuscitate or?

Do not resuscitate orders are typically initiated by a patient's physician, in consultation with the patient or their healthcare proxy.

How to fill out do not resuscitate or?

Do not resuscitate orders must be completed by a physician and signed by the patient or their healthcare proxy.

What is the purpose of do not resuscitate or?

The purpose of a do not resuscitate order is to respect a patient's wishes regarding end-of-life care and avoid unnecessary or unwanted medical interventions.

What information must be reported on do not resuscitate or?

A do not resuscitate order must include the patient's name, the physician's signature, and a statement indicating the patient's wishes not to be resuscitated in case of cardiac or respiratory arrest.

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