Do-Not-Resuscitate (DNR) Forms

How to use Carepatron's DNR Form

Follow the steps below to complete a do-not-resuscitate order. This living will form allows individuals to make their wishes known regarding resuscitation efforts in the event of cardiac or respiratory arrest.

Step 1: Download the template

Begin by downloading the Do-Not-Resuscitate order template. This form is essential to outline the individual’s wishes regarding resuscitation efforts.

Step 2:  Fill in patient and physician details

Enter the patient’s full name, date of birth, and address. Also, include the attending physician's name and contact information to verify and communicate the order.

Step 3: State the DNR request

Clearly state the individual’s wish not to resuscitate and not receive CPR or other life-sustaining measures in the event of cardiac or respiratory arrest. Specify any medical interventions to be avoided, such as chest compressions or artificial nutrition.

Step 4: Add a healthcare proxy or legal representative

If applicable, include the name and contact details of a designated healthcare proxy or legal representative to make healthcare decisions on the individual’s behalf.

Step 5: Witness signatures

Ensure the form is signed by at least two witnesses not involved in the individual’s healthcare or estate. These signatures validate the form’s authenticity.

Step 6: Distribute copies and store the original

After the form is completed and signed, make copies for relevant healthcare providers, emergency medical services (EMS), and the healthcare proxy. Store the original document with the individual’s medical records for easy access in a medical emergency.

When to use this form?

A DNR Form should be used when an individual explicitly wishes not to receive life-sustaining treatment or medical interventions in the event of a medical emergency, such as cardiac arrest or respiratory failure. Key instances include:

• Terminal illness or poor prognosis: A DNR order is often appropriate for individuals with terminal conditions where recovery is unlikely.
• Personal wishes: Individuals may decide to forgo CPR and other aggressive measures, based on their values and preferences.
• Quality of life considerations: When the burden of resuscitation outweighs the potential benefits, a DNR ensures that the individual’s wishes are respected.
• Informed decision-making: Establishing a DNR should involve clear communication with healthcare providers, ensuring the patient fully understands the implications of their choice.
• Advance directives: DNR orders may be documented in advance directives or other medical orders, ensuring legal validity and guiding future healthcare decisions.
• Healthcare professionals' guidance: Physicians and physician assistants may recommend a DNR order based on the patient’s health status and prognosis.
• EMS awareness: It’s essential that EMS providers are informed of the DNR order so they can respect the patient’s wishes during a medical emergency.
• Healthcare agents: If the patient has designated a healthcare agent, this individual may make medical decisions, including establishing a DNR order.

How to write a DNR Form

A do-not-resuscitate form is a legal document outlining an individual’s wish not to receive cardiopulmonary resuscitation or other life-sustaining measures, such as chest compressions, in the event of cardiac or respiratory arrest.

This document ensures that healthcare professionals, including physicians and medical staff, understand and respect the patient’s wishes regarding life-saving measures. The process of creating a DNR form may differ by jurisdiction, so consulting with a healthcare provider or legal expert is crucial to ensure compliance with local laws.

Here are the general steps to write a DNR form:

1. Identify the document: Title the form clearly as “Do-Not-Resuscitate Order” or “DNR Directive.”
2. Personal information: Include the individual's full legal name, date of birth, address, and other identifying information.
3. Healthcare proxy or legal representative: If applicable, name the person designated as the healthcare proxy or legal representative and provide their contact details.
4. Physician information: Include the attending physician's name, contact details, and signature, as they are the ones issuing the DNR order based on physician-patient discussions.
5. Statement of DNR request: Clearly state the individual's desire to avoid resuscitation efforts such as CPR, artificial ventilation, chest compressions, and other treatments like artificial nutrition if breathing stops. Be specific about the medical interventions covered by the DNR.
6. Duration of DNR order: Specify whether the DNR is permanent or if there are particular conditions or an effective date for its implementation.
7. Witness signatures: Have the form signed by at least two witnesses who are not involved in the patient’s healthcare and have no financial interest in the patient’s estate. These witnesses must acknowledge the document's signing in the patient's presence.
8. Notary public (Optional): In some regions, it’s advisable to have the DNR form notarized by a notary public for additional legal validity.
9. Copies and distribution: Make copies of the signed and witnessed form and distribute them to the patient’s healthcare providers, including the physician, primary care physician, and emergency medical services (EMS). Keep a copy in a visible location for easy access in a medical emergency.
10. Review and renewal: Review the DNR order periodically, especially if the patient’s condition or preferences change. Ensure that any changes are documented and signed by the necessary parties.
11. Document retrieval: Ensure that the DNR form is easily accessible to medical staff, first responders, and healthcare providers to avoid confusion during a medical emergency.