DNR Order Form Template

What This DNR Order Form Template Covers

The DNR order form template is designed to clearly outline a patient's preferences regarding resuscitation efforts in the event of a medical emergency. This template includes essential components such as Patient Information, Order Type, Physician Order, Scope of Order, Patient Capacity, and Signatures. Each section ensures that the patient's resuscitation preferences are documented and communicated effectively to healthcare providers.

When to Use a Do Not Resuscitate Form

This DNR order form is crucial in various scenarios, such as when a patient is diagnosed with a terminal illness and wishes to avoid invasive life-saving measures. It is also used by patients undergoing serious medical procedures where resuscitation may not align with their wishes. Additionally, family members can utilize this template to honor a loved one's preferences regarding end-of-life care decisions.

What's Included in This DNR Directive Template

• Patient Information: Collects vital details including full name, date of birth, and address to ensure the order is accurately associated with the correct individual.
• Order Type: Specifies the type of DNR order being requested, whether it is a full DNR or a partial DNR.
• Physician Order: Requires a physician's signature to validate the DNR order, ensuring it complies with medical regulations.
• Scope of Order: Defines the extent to which resuscitation efforts should be withheld, providing clarity on patient resuscitation preferences.
• Patient Capacity: Assesses whether the patient is capable of making informed decisions regarding their healthcare.
• Signatures: Ensures that all necessary parties, including the patient and healthcare provider, have signed the document, making it legally binding.

Key Medical Order for Life-Sustaining Treatment Provisions

• Clear Communication: This DNR order form template facilitates clear communication of the patient's wishes to medical professionals, reducing confusion during critical moments.
• Legal Protection: By formalizing the patient's preferences, this template provides legal protection for healthcare providers and family members against unwanted medical interventions.
• Respect for Patient Autonomy: This document upholds the patient's right to make decisions regarding their medical treatment, ensuring their values and preferences are respected.

Disclaimer: This template is for informational purposes only and does not constitute legal advice.