Attorney-Approved Pennsylvania Do Not Resuscitate Order Document

Attorney-Approved Pennsylvania Do Not Resuscitate Order Document

A Pennsylvania Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. By completing this form, you can ensure that your preferences for end-of-life care are respected. To take control of your healthcare decisions, consider filling out the DNR form by clicking the button below.

Article Guide

In Pennsylvania, the Do Not Resuscitate (DNR) Order form plays a crucial role in ensuring that individuals can express their wishes regarding medical treatment in critical situations. This legally binding document is designed for those who wish to forgo life-sustaining treatments, such as cardiopulmonary resuscitation (CPR), in the event of a cardiac or respiratory arrest. Understanding the DNR form is essential for patients, families, and healthcare providers alike, as it provides clarity during emotionally charged moments. The form requires the signature of both the patient and a physician, affirming that the decision is informed and voluntary. Additionally, it must be readily accessible to emergency medical personnel, ensuring that one’s preferences are respected at all times. By navigating the nuances of the Pennsylvania DNR Order, individuals can take proactive steps in managing their end-of-life care, fostering peace of mind for themselves and their loved ones.

Pennsylvania Do Not Resuscitate Order Preview

Pennsylvania Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is established in accordance with the laws of the Commonwealth of Pennsylvania. It is intended to communicate the wishes of the individual regarding resuscitation efforts in the event of a medical emergency.

Patient Information:

  • Name: ________________________________
  • Date of Birth: ________________________
  • Address: ______________________________
  • City: _________________________________
  • State: ________________________________
  • Zip Code: _____________________________

Medical Information:

  • Primary Physician: ______________________
  • Physician's Contact Number: ____________

Patient's Wishes:

The patient hereby expresses the wish that in the event of cardiac arrest or respiratory failure, no resuscitation efforts be made. This includes, but is not limited to, the following:

  1. Cardiopulmonary resuscitation (CPR)
  2. Advanced cardiac life support (ACLS)
  3. Intubation or mechanical ventilation

Signature:

By signing below, I confirm that I understand the implications of this Do Not Resuscitate Order and that it reflects my wishes regarding medical treatment.

Patient's Signature: ___________________________

Date: ______________________________________

Witness Information:

  • Name: ________________________________
  • Signature: ___________________________
  • Date: _________________________________

This DNR Order should be placed in the patient's medical record and a copy should be kept with the patient at all times.

Form Attributes

Fact Name Description
Legal Authority The Pennsylvania Do Not Resuscitate Order form is governed by the Pennsylvania Consolidated Statutes, Title 20, Chapter 54.
Purpose This form allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency.
Eligibility Any adult or emancipated minor can complete a Do Not Resuscitate Order in Pennsylvania.
Signature Requirements The form must be signed by the patient and a physician to be valid and recognized in medical settings.

How to Use Pennsylvania Do Not Resuscitate Order

Filling out the Pennsylvania Do Not Resuscitate Order form is an important step for individuals who wish to express their healthcare preferences. This document helps ensure that your wishes are respected in medical situations where resuscitation might be considered. Follow the steps below to complete the form accurately.

  1. Obtain the Pennsylvania Do Not Resuscitate Order form. You can find it online or request it from your healthcare provider.
  2. Read the instructions carefully. Make sure you understand what the form entails before proceeding.
  3. Fill in your personal information. This includes your full name, date of birth, and address.
  4. Indicate whether you are the patient or the patient's legal representative. If you are a representative, provide your relationship to the patient.
  5. Sign and date the form. Ensure that you are signing in the designated area.
  6. Have the form witnessed. Pennsylvania law requires that the signature be witnessed by two individuals who are not related to you and who do not stand to gain from your death.
  7. Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and any family members involved in your care.
  8. Review the form periodically. Ensure that it still reflects your wishes, especially if your health status changes.

Key Facts about Pennsylvania Do Not Resuscitate Order

What is a Pennsylvania Do Not Resuscitate Order (DNR) form?

A Pennsylvania Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form indicates that a person does not want to receive cardiopulmonary resuscitation (CPR) or other life-sustaining treatments if their heart stops beating or they stop breathing. It is important for this document to be completed and signed by a physician to be valid.

Who can complete a DNR form in Pennsylvania?

Any adult who is capable of making their own medical decisions can complete a DNR form. This includes individuals who are facing a terminal illness or have a medical condition that significantly impacts their quality of life. A physician must also sign the form to ensure that it reflects informed medical decision-making.

How do I obtain a DNR form in Pennsylvania?

DNR forms can be obtained from various sources, including hospitals, healthcare providers, and online through the Pennsylvania Department of Health website. It is advisable to discuss your wishes with a healthcare professional who can provide guidance and ensure that the form is filled out correctly.

Is a DNR order valid outside of a hospital setting?

Yes, a DNR order is valid in both hospital and out-of-hospital settings in Pennsylvania. However, it is crucial to ensure that the form is readily available and that emergency medical personnel are aware of its existence. Carrying a copy with you or wearing a medical alert bracelet can help ensure that your wishes are honored.

Can a DNR order be revoked?

Yes, a DNR order can be revoked at any time by the individual who signed it or by their legally authorized representative. To revoke the order, simply destroy the original document and inform healthcare providers of the change in wishes. It is advisable to complete a new DNR form if you wish to establish a new set of instructions.

What happens if a DNR order is not followed?

If a DNR order is not followed, it can lead to legal and ethical complications for healthcare providers. In Pennsylvania, healthcare professionals are required to respect a valid DNR order. If a DNR is ignored, it may result in legal action against the healthcare provider for failing to comply with the patient's wishes.

Can family members override a DNR order?

Family members cannot override a DNR order that has been legally signed by the patient and their physician. However, if the patient is unable to communicate or is incapacitated, family members may be involved in discussions about treatment options. It is essential for individuals to communicate their wishes clearly to their loved ones to prevent confusion.

What should I do after completing a DNR form?

After completing a DNR form, it is important to keep it in a safe but accessible place. Share copies with your healthcare providers, family members, and anyone else involved in your care. Regularly review the document to ensure it still reflects your wishes, especially if your health status changes.

Common mistakes

Filling out a Do Not Resuscitate (DNR) Order form in Pennsylvania is a significant decision that requires careful consideration. Unfortunately, many individuals make common mistakes that can lead to confusion or unintended consequences. Understanding these pitfalls can help ensure that your wishes are clearly communicated and respected.

One frequent mistake is not having a healthcare provider involved in the process. The DNR Order must be signed by a physician to be valid. Without this crucial step, the document may not hold any legal weight. It’s essential to consult with a healthcare professional who can explain the implications of a DNR and help you understand your options.

Another common error is failing to communicate your wishes with family members and loved ones. Even if the DNR form is properly filled out and signed, it can lead to conflict or confusion if your family is unaware of your intentions. Open discussions about your healthcare preferences can prevent misunderstandings and ensure that everyone is on the same page during critical moments.

Additionally, people often overlook the importance of reviewing and updating their DNR Orders. Life circumstances can change, and so can your preferences regarding medical care. Regularly revisiting your DNR Order ensures that it accurately reflects your current wishes. Failing to do so may result in a document that no longer aligns with your values or desires.

Finally, some individuals may mistakenly believe that a DNR Order applies to all medical situations. In reality, a DNR specifically addresses resuscitation efforts in the event of cardiac or respiratory arrest. It does not limit other forms of medical treatment. Understanding this distinction is crucial to ensure that your overall healthcare preferences are met.

Documents used along the form

The Pennsylvania Do Not Resuscitate (DNR) Order form is an important document for individuals who wish to express their preferences regarding resuscitation in medical emergencies. In addition to this form, several other documents can help clarify a person's healthcare wishes. Below is a list of related forms and documents commonly used in conjunction with the DNR Order.

  • Advance Healthcare Directive: This document allows individuals to outline their healthcare preferences and appoint someone to make decisions on their behalf if they become unable to communicate.
  • Living Will: A living will specifies the types of medical treatment an individual wishes to receive or not receive in situations where they cannot express their wishes due to illness or incapacitation.
  • Healthcare Power of Attorney: This legal document designates a trusted person to make healthcare decisions for someone if they are unable to do so themselves, ensuring their wishes are respected.
  • Physician Orders for Life-Sustaining Treatment (POLST): A POLST form translates a patient’s wishes regarding life-sustaining treatments into actionable medical orders, guiding healthcare providers in emergencies.
  • Do Not Intubate (DNI) Order: This order specifically instructs medical personnel not to insert a breathing tube, focusing on the patient’s preferences regarding airway management.
  • Comfort Care Order: This document outlines preferences for palliative care, prioritizing comfort and quality of life over aggressive treatment measures in end-of-life situations.

These documents work together to ensure that an individual's healthcare preferences are clearly communicated and respected in various medical situations. It's essential to have these forms completed and accessible to avoid confusion during critical moments.

Similar forms

A Do Not Resuscitate (DNR) Order is an important document that outlines a person's wishes regarding medical treatment in case of a medical emergency. There are several other documents that serve similar purposes, helping individuals express their healthcare preferences. Here are eight documents that share similarities with a DNR Order:

  • Living Will: This document specifies an individual's preferences regarding medical treatments and interventions in situations where they are unable to communicate their wishes. Like a DNR, it guides healthcare providers in making decisions aligned with the patient's desires.
  • Durable Power of Attorney for Healthcare: This legal document allows a person to appoint someone else to make healthcare decisions on their behalf if they become incapacitated. It complements a DNR by ensuring that a trusted individual can advocate for the patient's wishes.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that outlines a patient’s preferences for life-sustaining treatments. It is similar to a DNR in that it provides clear instructions for emergency medical personnel, ensuring that the patient’s wishes are respected.
  • Advance Healthcare Directive: This document combines a living will and a durable power of attorney for healthcare. It allows individuals to outline their healthcare preferences and designate someone to make decisions if they are unable to do so themselves, similar to a DNR.
  • Healthcare Proxy: A healthcare proxy is a specific type of durable power of attorney focused on medical decisions. It allows someone to make choices on behalf of the patient, ensuring that their wishes, like those expressed in a DNR, are honored.
  • Do Not Intubate (DNI) Order: A DNI order specifically instructs medical personnel not to insert a breathing tube if the patient is unable to breathe on their own. This is similar to a DNR in that it outlines specific medical interventions that the patient does not want.
  • Comfort Care Order: This document focuses on providing comfort and pain relief rather than aggressive treatments. It aligns with the intentions of a DNR by emphasizing quality of life and the patient's preferences in end-of-life care.
  • Patient Advocate Designation: This document allows an individual to designate a patient advocate to represent their interests in healthcare decisions. It works alongside a DNR by ensuring that someone is in place to uphold the patient's wishes in critical situations.

Understanding these documents can empower individuals to make informed decisions about their healthcare and ensure their preferences are respected in times of need.

Dos and Don'ts

When filling out the Pennsylvania Do Not Resuscitate Order form, it’s essential to approach the process with care. Here are some important dos and don’ts to keep in mind:

  • Do ensure that you understand the implications of the order. This document communicates your wishes regarding resuscitation efforts in case of a medical emergency.
  • Do discuss your decision with your healthcare provider. They can provide guidance and help clarify any questions you may have.
  • Do have the form signed by a physician. A valid DNR order requires a doctor's signature to be legally recognized.
  • Do keep copies of the completed form in accessible locations. Share them with family members and your healthcare team.
  • Don’t fill out the form without fully understanding its contents. Take the time to read and comprehend each section.
  • Don’t forget to update the order if your wishes change. Life circumstances can alter your preferences regarding medical treatment.

By following these guidelines, you can ensure that your wishes are clearly communicated and respected. It’s a significant step in planning for your healthcare needs.

Misconceptions

Understanding the Pennsylvania Do Not Resuscitate (DNR) Order form is crucial for patients and their families. However, several misconceptions often cloud the clarity of this important document. Below is a list of common misunderstandings:

  1. A DNR means I will not receive any medical treatment. Many believe that a DNR order implies a complete withdrawal of all medical care. In reality, a DNR only affects resuscitation efforts in the event of cardiac or respiratory arrest. Other treatments, such as pain management and comfort care, continue as needed.
  2. I can only have a DNR if I am terminally ill. Some think that only patients with terminal conditions can request a DNR. However, anyone can choose to have a DNR, regardless of their health status, if they wish to avoid resuscitation in specific situations.
  3. A DNR is the same as a living will. While both documents express healthcare preferences, they serve different purposes. A living will outlines a person’s wishes regarding medical treatment in various scenarios, while a DNR specifically addresses resuscitation efforts.
  4. Many assume that legal representation is necessary to fill out a DNR order. In Pennsylvania, individuals can complete the form without legal assistance, as long as they understand its implications.
  5. Some people fear that signing a DNR is permanent. In fact, individuals can revoke or modify their DNR orders at any time, provided they communicate their wishes clearly.
  6. There is a misconception that family members can override a DNR order. In Pennsylvania, a DNR is a legal document that must be respected, even if family members disagree.
  7. Many believe that DNR orders are limited to hospital settings. However, a valid DNR can be honored in various healthcare environments, including at home or in long-term care facilities.
  8. While a physician’s signature is recommended, Pennsylvania law allows for a DNR to be valid if it is completed and signed by the patient or their authorized representative, even without a physician’s signature.
  9. Some view a DNR as a surrender to illness. In truth, many individuals choose DNRs to ensure that their end-of-life wishes are honored, focusing on quality of life rather than aggressive interventions.
  10. This misconception leads to a lack of communication. In reality, discussing DNR preferences with healthcare providers is essential. It ensures that everyone understands the patient’s wishes and can provide appropriate care.

Clearing up these misconceptions can empower individuals to make informed decisions about their healthcare preferences. Understanding the nuances of a DNR order is vital for ensuring that one’s wishes are respected during critical moments.

Key takeaways

Filling out a Do Not Resuscitate (DNR) Order form in Pennsylvania is an important step for individuals who wish to express their medical preferences. Here are some key takeaways to keep in mind:

  • The DNR Order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a person stops breathing or their heart stops beating.
  • To be valid, the DNR form must be signed by a physician and the patient or their legal representative.
  • It is essential to discuss your wishes with your healthcare provider before completing the form. This ensures that your decisions are understood and respected.
  • The DNR Order should be easily accessible. Keep a copy at home and provide one to your healthcare provider, family members, and any caregivers.
  • In Pennsylvania, the DNR Order is recognized in all healthcare settings, including hospitals, nursing homes, and emergency medical services.
  • Review your DNR Order regularly. Changes in your health status or personal preferences may require updates to the document.
  • It is important to understand that a DNR Order does not affect other treatments. You can still receive care for pain management and other medical needs.