Homepage Blank Do Not Resuscitate Order Form Valid Pennsylvania Do Not Resuscitate Order Template
Content Navigation

In Pennsylvania, the Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals who wish to express their preferences regarding medical treatment in the event of a life-threatening situation. This form is particularly important for those who have serious health conditions or are nearing the end of life, as it allows them to communicate their wishes about resuscitation efforts. The DNR Order specifies that if a person’s heart stops beating or they stop breathing, healthcare providers should not perform cardiopulmonary resuscitation (CPR) or other life-saving measures. To ensure that these wishes are respected, the form must be completed correctly and signed by both the patient and a physician. Additionally, the DNR Order must be readily accessible, often kept in a visible location, such as on the refrigerator or with medical records. Understanding the implications of this form, including how it interacts with other medical directives and the importance of discussing it with family and healthcare providers, can empower individuals to make informed decisions about their healthcare preferences.

Document Example

Pennsylvania Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is intended to provide clear instructions regarding resuscitation efforts in case of a medical emergency, following Pennsylvania state laws regarding advance directives.

Patient Information:

  • Name: _______________________________
  • Date of Birth: ______________________
  • Address: ____________________________
  • Phone Number: ______________________
  • Emergency Contact Name: ______________
  • Emergency Contact Phone Number: _________

Physician Information:

  • Physician’s Name: ______________________
  • Physician’s Contact Number: ______________
  • Medical License Number: __________________

This order specifies that in the event of cardiac arrest or respiratory failure, the patient identified above should not receive cardiopulmonary resuscitation (CPR) or other resuscitative measures.

Conformance with Pennsylvania Law: This document complies with the Pennsylvania Do Not Resuscitate Law, Act 2 of 1992, which outlines the rights of patients and the requirements for DNR orders.

Signature of Patient or Legal Representative:

Signature: __________________________

Date: ______________________________

Witness Signature:

Witness Name: ______________________

Witness Signature: ___________________

Date: ______________________________

Frequently Asked Questions

  1. What is a Do Not Resuscitate (DNR) Order?

    A Do Not Resuscitate Order is a legal document that allows a person to refuse resuscitation in the event of a cardiac or respiratory arrest. This means that if the heart stops beating or a person stops breathing, medical personnel will not perform CPR or other life-saving measures.

  2. Who can request a DNR Order in Pennsylvania?

    In Pennsylvania, a DNR Order can be requested by a patient who is at least 18 years old and is capable of making their own medical decisions. If the patient is unable to make decisions, a designated healthcare representative or legal guardian can request the order on their behalf.

  3. How do I obtain a DNR Order form?

    You can obtain a DNR Order form from various sources. These include hospitals, healthcare providers, or online through the Pennsylvania Department of Health’s website. It is important to ensure that the form you use is the official state-approved version.

  4. What information is required on the DNR Order form?

    The DNR Order form requires specific information, including the patient’s name, date of birth, and signature. It must also include the signatures of the physician and, if applicable, a healthcare representative. This ensures that the order is valid and recognized by medical personnel.

  5. Is a DNR Order valid outside of a hospital setting?

    Yes, a DNR Order is valid in both hospital and non-hospital settings. However, it is essential to have the DNR form readily available and clearly visible to ensure that emergency responders can easily access it when needed.

  6. Can a DNR Order be revoked?

    Yes, a DNR Order can be revoked at any time. The patient or their authorized representative can simply destroy the form or inform medical personnel that they wish to cancel the order. It is advisable to document this revocation in writing for clarity.

  7. What should I discuss with my doctor before completing a DNR Order?

    Before completing a DNR Order, it is important to have an open conversation with your doctor. Discuss your health condition, prognosis, and personal values regarding end-of-life care. This will help ensure that your wishes are understood and respected.

Misconceptions

Understanding the Pennsylvania Do Not Resuscitate (DNR) Order form can be challenging. Many people hold misconceptions about what it entails. Here are six common misunderstandings:

  • A DNR order means no medical care at all. This is not true. A DNR order specifically addresses resuscitation efforts in the event of cardiac arrest. Other medical treatments can still be provided, including pain management and comfort care.
  • Only terminally ill patients can have a DNR order. This misconception overlooks that anyone can request a DNR order, regardless of their health status. It is a personal choice based on individual preferences about end-of-life care.
  • A DNR order is permanent and cannot be changed. In reality, a DNR order can be revoked or modified at any time. Individuals can discuss their wishes with their healthcare providers and update the order as needed.
  • Family members can make DNR decisions without consent. A DNR order must be signed by the patient or their legally appointed representative. Family members cannot unilaterally decide on a DNR order without proper authority.
  • The DNR order is only valid in hospitals. This is incorrect. A properly executed DNR order is valid in various settings, including at home, in nursing facilities, and in hospice care.
  • Having a DNR order means giving up on life. Many people mistakenly believe that a DNR order signifies a desire to die. In truth, it reflects a person's wishes regarding specific medical interventions and can align with their values about quality of life.

Being informed about the Pennsylvania DNR order can help individuals make decisions that reflect their values and preferences regarding medical care.

Common mistakes

  1. Failing to complete all required sections of the form. Each section must be filled out to ensure the document is valid.

  2. Not having the form signed by the patient or their authorized representative. A signature is necessary to confirm the patient's wishes.

  3. Overlooking the need for a witness signature. Many states, including Pennsylvania, require a witness to sign the document.

  4. Using outdated versions of the form. Always ensure you are using the most current version to avoid legal complications.

  5. Neglecting to discuss the decision with family members or healthcare providers. Open communication can prevent misunderstandings.

  6. Not providing copies of the completed form to relevant parties. Distributing copies to healthcare providers and family members is crucial.

  7. Filling out the form under pressure or without understanding its implications. Take the time to fully comprehend the consequences of a DNR order.

  8. Failing to update the form when circumstances change. Regular reviews of the document are essential to reflect the patient's current wishes.

  9. Assuming that verbal instructions are sufficient. Written documentation is necessary to ensure that the DNR wishes are honored.

PDF Attributes

Fact Name Description
Definition A Pennsylvania Do Not Resuscitate (DNR) Order is a legal document that allows a person to refuse resuscitation efforts in the event of a cardiac or respiratory arrest.
Governing Law The DNR Order in Pennsylvania is governed by the Pennsylvania Consolidated Statutes, Title 20, Chapter 54.
Eligibility Any adult capable of making health care decisions can complete a DNR Order. This includes individuals who are terminally ill or in a persistent vegetative state.
Signature Requirements The DNR Order must be signed by the individual or their authorized representative, along with the signature of a physician.
Form Availability The official DNR Order form is available through various healthcare providers, hospitals, and the Pennsylvania Department of Health.
Emergency Services Emergency medical personnel are required to honor a valid DNR Order. It must be presented at the time of emergency response.
Revocation A DNR Order can be revoked at any time by the individual or their authorized representative, and this revocation must be documented.

Similar forms

The Pennsylvania Do Not Resuscitate (DNR) Order form is similar to the Advance Healthcare Directive. An Advance Healthcare Directive allows individuals to outline their preferences regarding medical treatment and appoint a healthcare proxy. Like the DNR, it serves to communicate a person's wishes in situations where they cannot speak for themselves, ensuring that their medical care aligns with their values and desires.

Another document similar to the DNR is the Physician Orders for Life-Sustaining Treatment (POLST) form. POLST is a medical order that specifies a patient's preferences for treatments such as resuscitation, intubation, and other life-sustaining measures. Both the DNR and POLST aim to provide clarity on a patient's wishes, but POLST is typically more comprehensive and includes additional treatment options.

The Living Will is also comparable to the DNR form. A Living Will is a legal document that details an individual's preferences for end-of-life care. While a DNR specifically addresses resuscitation efforts, a Living Will covers a broader range of medical interventions, allowing individuals to express their wishes regarding life support, pain management, and other critical decisions.

The Healthcare Power of Attorney (POA) shares similarities with the DNR as well. This document designates a trusted individual to make healthcare decisions on behalf of someone who is incapacitated. While the DNR specifies the refusal of resuscitation, the Healthcare POA empowers the appointed agent to make decisions that align with the patient’s overall healthcare preferences.

In addition, the Medical Order for Life-Sustaining Treatment (MOLST) form is akin to the DNR. Like POLST, MOLST is a physician's order that outlines a patient's preferences for life-sustaining treatment. Both documents serve to ensure that healthcare providers understand and respect the patient's wishes, although MOLST may be more commonly used in certain states.

The Comfort Care Order is another document that aligns with the principles of a DNR. This order emphasizes the provision of comfort and palliative care rather than aggressive life-saving measures. It directs healthcare providers to focus on alleviating pain and enhancing quality of life, similar to the intentions behind a DNR.

The Do Not Intubate (DNI) order is closely related to the DNR. A DNI order specifically instructs healthcare providers not to perform intubation in the event of respiratory failure. While a DNR addresses all resuscitation efforts, the DNI focuses solely on airway management, thus complementing the overall goals of the DNR.

In the realm of mobile home transactions, the accurate completion of necessary forms is essential to ensure smooth transfers of ownership. For instance, the documentonline.org/blank-new-york-mobile-home-bill-of-sale serves as a pivotal resource for buyers and sellers alike, documenting critical details about the property being sold while providing assurance that the transaction is recorded properly. Understanding the importance of such documents can alleviate potential disputes and streamline the selling process.

The End-of-Life Care Plan is also comparable to the DNR form. This plan outlines a patient's preferences for care during their final days. It encompasses various aspects of care, including pain management and emotional support, while a DNR specifically addresses resuscitation efforts, making both documents essential for end-of-life decision-making.

Finally, the Hospice Care Plan shares similarities with the DNR. A Hospice Care Plan is designed for individuals with terminal illnesses, focusing on comfort and quality of life. It includes directives that may overlap with those in a DNR, as both prioritize the patient’s wishes regarding aggressive treatments and emphasize compassionate care.