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LILAC FORM STAYS WITH PERSON WHEREVER THEY ARE BEING CARED FOR.
WHITE FORMS FOR Audit AND NOTES.UNIFIED DO NOT ATTEMPT CARDIOPULMONARY RESUSCITATION (DNA CPR)
In the event of cardiac or respiratory
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How to fill out do not attempt resusitation

How to fill out do not attempt resusitation
01
To fill out a do not attempt resuscitation (DNAR) form, follow these steps:
02
Begin by obtaining the DNAR form. You can usually get one from a healthcare provider, hospital, or hospice.
03
Read the form carefully to understand its purpose and contents.
04
Fill in the patient's personal information, such as their name, date of birth, and contact information.
05
Specify the decision by checking the appropriate box indicating the patient's preference for resuscitation or non-resuscitation.
06
If applicable, state any specific instructions regarding resuscitation techniques or interventions to be withheld or performed.
07
If desired, you can appoint a healthcare proxy or a person to make decisions on the patient's behalf in case they are unable to do so.
08
Once all the required information is filled out, sign and date the form.
09
Make copies of the completed DNAR form for the patient, family members, healthcare providers, and any relevant medical facility.
10
Keep the original form in a safe and easily accessible place, and inform the patient's healthcare team about its existence.
11
Review and update the DNAR form as needed or when there are changes in the patient's medical condition or preferences.
Who needs do not attempt resusitation?
01
Not everyone needs a do not attempt resuscitation (DNAR) order, but it is typically considered in the following situations:
02
Patients with advanced or terminal illnesses who have expressed a wish to avoid interventions like cardiopulmonary resuscitation (CPR) if their heart stops or they stop breathing.
03
Patients who have severe health conditions or are in a critical state, and the healthcare team determines that attempted resuscitation would be futile or only prolong suffering.
04
Individuals with conditions or diseases that significantly reduce their quality of life and who have made a personal decision to forgo resuscitation measures.
05
Older adults with multiple chronic illnesses or frailty who may not benefit from resuscitation attempts due to their overall health status.
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What is do not attempt resusitation?
Do not attempt resusitation (DNAR) is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in case of cardiac or respiratory arrest.
Who is required to file do not attempt resusitation?
Do not attempt resusitation (DNAR) forms are typically completed by patients or their legal representatives in consultation with healthcare providers.
How to fill out do not attempt resusitation?
To fill out a do not attempt resusitation (DNAR) form, patients or legal representatives should discuss their wishes with healthcare providers and complete the relevant documentation.
What is the purpose of do not attempt resusitation?
The purpose of a do not attempt resusitation (DNAR) order is to respect the wishes of patients who do not want to undergo aggressive life-saving measures in certain situations.
What information must be reported on do not attempt resusitation?
A do not attempt resusitation (DNAR) form typically includes the patient's name, signature or legal representative's signature, date of signing, and specific instructions regarding resuscitation.
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