Get the free DO NOT RESUSCITATE - DNR

POLICY NO:508DATE ISSUED:09/1993DATE REVIEWED/REVISED: 06/2016 DATE TO BE REVIEWED:01/2018EMERGENCY MEDICAL SERVICES DO NOT RESUSCITATE DNR Purpose: To establish criteria for a Do Not Resuscitate

How to fill out do not resuscitate

How to fill out do not resuscitate:

1. Determine your eligibility: Before filling out a do not resuscitate (DNR) form, it is important to understand who is eligible for it. Typically, a DNR is meant for individuals with terminal illnesses, advanced age, or those who have explicitly expressed their desire to not receive life-saving measures in case of cardiac or respiratory arrest.
2. Consult with your healthcare provider: It is recommended to discuss your decision to fill out a DNR form with your healthcare provider. They can provide you with the necessary information, answer any questions you may have, and guide you through the process.
3. Obtain the DNR form: Contact your local healthcare facility, hospice, or state health department to obtain a valid DNR form. Different regions may have specific forms, so make sure you acquire the appropriate one for your location.
4. Complete the form accurately: The DNR form will typically require you to provide personal information such as your name, date of birth, address, and contact details. Follow the instructions provided on the form to accurately fill out each section.
5. Discuss your decision: It is important to discuss your decision with your loved ones and healthcare proxy, if applicable. Ensure they are aware of your wishes and understand the purpose of the DNR form. This can help avoid potential confusion or conflicts in the future.
6. Sign the form: Once you have completed all the necessary sections, sign the DNR form in the designated areas. In some cases, a witness or healthcare professional may also need to sign the form to validate it.

Who needs do not resuscitate:

1. Individuals with terminal illnesses: Those who have been diagnosed with a terminal illness and do not wish to have life-saving measures, such as cardiopulmonary resuscitation (CPR), performed on them may consider a DNR.
2. Elderly individuals: Advanced age can sometimes come with certain health complications. Older adults who have discussed their preferences with their healthcare provider may opt for a DNR to avoid aggressive life-saving interventions.
3. Individuals with specific medical conditions: Some individuals with specific medical conditions, such as end-stage organ failure or severe cognitive impairments, may choose a DNR as part of their advance care planning.
4. Individuals with limited quality of life: Those who have determined that their quality of life would be significantly diminished even if resuscitated may opt for a DNR. This could include individuals with irreversible conditions or severe physical limitations.

Note: It is important to remember that the decision to have a DNR is a personal one and should be made after careful consideration and consultation with healthcare professionals and loved ones.

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