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The Illinois Department of Public Health (IDPH) Do Not Resuscitate (DNR)/Practitioner Orders for Life Sustaining Treatment (POLST) is a voluntary form that records a patient\'s wishes regarding medical
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How to fill out idph dnrpolst form

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How to fill out idph dnrpolst form

01
Obtain the IDPH DNR/DNAR POLST form from a healthcare provider or download it from the Illinois Department of Public Health website.
02
Fill out the patient's information at the top of the form, including name, date of birth, and medical record number.
03
Discuss the patient's health care goals and preferences with the healthcare provider to determine which medical interventions they want or do not want.
04
Circle the appropriate instructions for resuscitation and other medical treatments based on the patient's wishes.
05
Ensure that the form is signed and dated by the patient or their legal representative.
06
Have the healthcare provider sign and date the form as well.
07
Make copies of the completed form for the patient, healthcare provider, and any other relevant parties.

Who needs idph dnrpolst form?

01
Individuals with serious or terminal illnesses.
02
Patients who wish to specify their preferences for medical treatment in emergency situations.
03
Patients who are in long-term care or hospice services.
04
Anyone who wants to communicate their end-of-life care wishes to healthcare providers.
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The IDPH DNRPOLST form is a medical order for emergency medical services and healthcare providers in Illinois, initiating Do Not Resuscitate (DNR) protocols for patients who wish to forego resuscitation efforts.
The IDPH DNRPOLST form is typically completed by patients with serious illnesses or advanced directives, in collaboration with their healthcare providers or authorized representatives.
To fill out the IDPH DNRPOLST form, individuals must provide personal information, specify treatment preferences, and sign the document with a witness or healthcare professional, ensuring it is acknowledged in medical records.
The purpose of the IDPH DNRPOLST form is to ensure patients' wishes regarding resuscitation and other life-sustaining treatments are honored during medical emergencies.
The IDPH DNRPOLST form must include the patient's name, medical condition, preferences regarding resuscitation and other interventions, signature of the patient or their representative, and the signatures of witnesses or healthcare professionals.
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DNR Pediatric Life-Sustaining Treatment POLST Advance Directive Medical Orders Patient Wishes Health Care Power of Attorney Resuscitation Orders Comfort-Focused Treatment Medical Treatment Preferences

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