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DO NOT RESUSCITATE Prehospital DNR Request Form An Advanced Request to Limit the Scope of Emergency Medical Care I, request limited emergency care as herein described. (Name) I understand DNR means
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How to fill out do not resuscitate

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How to fill out a do not resuscitate (DNR) order:

01
Obtain the necessary forms: Begin by getting the DNR form from a healthcare provider or hospital. You may also be able to find it online or request a copy from your state's health department.
02
Read and understand the instructions: Take the time to thoroughly read and understand the instructions provided with the DNR form. Familiarize yourself with the purpose and implications of a DNR order.
03
Consult with your healthcare provider: It is important to have a discussion with your healthcare provider regarding your medical condition, prognosis, and the appropriateness of a DNR order. They can help answer any questions you may have and guide you through the process.
04
Complete the necessary information: Fill out the required information on the DNR form. This may include your personal details such as name, date of birth, and contact information.
05
Specify your wishes: Indicate your preferences regarding resuscitation. This may involve choosing between full resuscitation efforts, limited interventions, or no resuscitation at all. Make sure to be clear and specific about your intentions.
06
Sign and date the form: Once you have filled out the DNR form, sign and date it according to the instructions provided. Some forms may require additional signatures, such as from a witness or healthcare provider.
07
Distribute copies: Provide copies of the completed DNR form to relevant individuals, including your healthcare providers, family members, and designated caregivers. Ensure they understand and have access to the document in case of an emergency.

Who needs a do not resuscitate (DNR) order?

01
Individuals with terminal conditions: DNR orders are often considered by those with a terminal illness or in the end stages of a chronic condition. Such individuals may not wish to undergo resuscitation efforts that may only prolong their suffering without providing significant benefit.
02
Elderly individuals: Older adults who have chronic health issues or reduced quality of life may choose to have a DNR order in place to reflect their preferences regarding resuscitation.
03
Patients with severe comorbidities: Those with multiple serious medical conditions may opt for a DNR order to avoid further interventions, particularly if the chances of successful resuscitation are low or if it would only lead to further health complications.
04
Individuals with advanced directives: People who have created advance directives, such as living wills or durable power of attorney for healthcare, may include specific instructions regarding resuscitation preferences.
05
Those with religious or cultural beliefs: Some individuals may have religious or cultural beliefs that influence their decision about resuscitation. They may choose a DNR order to align with their personal beliefs and values.
It is important to note that the decision to have a DNR order is an individual one and should be made after careful consideration, discussions with healthcare professionals, and in consultation with loved ones.
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Do not resuscitate is a medical order indicating that CPR should not be performed if a patient's heart stops or if they stop breathing.
A do not resuscitate order is typically filed by a patient's physician after discussion with the patient or their legal guardian.
Do not resuscitate forms can be filled out by a patient's physician in consultation with the patient or their legal guardian.
The purpose of a do not resuscitate order is to respect the patient's wishes regarding end-of-life care and to avoid unnecessary medical interventions.
A do not resuscitate order typically includes the patient's name, date of birth, physician's signature, and the date the order was completed.
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