Attorney-Approved Washington Do Not Resuscitate Order Document

Attorney-Approved Washington Do Not Resuscitate Order Document

A Washington Do Not Resuscitate (DNR) Order form is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. It serves to respect the wishes of individuals who prefer not to undergo these life-saving measures. If you’d like to ensure your healthcare preferences are honored, fill out the form by clicking the button below.

Outline

The Washington Do Not Resuscitate (DNR) Order form serves as a critical tool for individuals wishing to express their end-of-life healthcare preferences. This legally binding document allows patients to communicate their desire to forgo resuscitation in the event of a cardiac or respiratory arrest. It is typically completed in consultation with healthcare providers, ensuring that the patient's wishes are understood and respected within medical settings. A DNR order must be signed by a physician and can be used in various environments, including hospitals, nursing homes, and at home. Information about the patient, including their medical condition and understanding of the DNR request, must be documented to validate the form. Furthermore, the order is designed to be easily accessible and should accompany the patient at all times, allowing emergency medical personnel to adhere to the patient's choices promptly and appropriately. Understanding the implications and requirements of the DNR order is essential for anyone considering this important decision about their medical care.

Washington Do Not Resuscitate Order Preview

Washington Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is executed in accordance with the Revised Code of Washington (RCW) 70.122, which allows individuals to express their wish not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining treatment in specific medical situations.

By completing this order, I declare my treatment preferences concerning resuscitation in the event of cardiac or respiratory failure.

Patient Information:

  • Patient Name: __________________________
  • Patient Date of Birth: __________________________
  • Patient Address: __________________________
  • Patient Phone Number: __________________________

Healthcare Provider Information:

  • Provider Name: __________________________
  • Provider Phone Number: __________________________
  • Provider Address: __________________________

Emergency Contact Information:

  • Contact Name: __________________________
  • Contact Phone Number: __________________________
  • Contact Relationship to Patient: __________________________

Patient’s Wishes:

  1. In the event of cardiac or respiratory arrest, I do not wish to receive cardiopulmonary resuscitation (CPR).
  2. I understand that this order may result in my death and that I am making this decision voluntarily.
  3. This order applies to all healthcare settings where medical assistance may be sought.

Signature: __________________________

Date: __________________________

Witness Signature: __________________________

Date: __________________________

This order should be kept in an accessible location and a copy provided to my healthcare provider and emergency contact.

Form Attributes

Fact Name Description
Purpose The Washington Do Not Resuscitate (DNR) Order form is designed to communicate a patient's wishes regarding resuscitation efforts in the event of cardiac or respiratory arrest.
Governing Law This form is governed by Washington State law, specifically RCW 70.122, which outlines the rights and procedures related to advance directives and DNR orders.
Legal Status A properly completed DNR Order is legally binding and must be honored by healthcare providers in Washington State.
Eligibility Any competent adult can create a DNR order, but it must be signed by the patient and their healthcare provider to be effective.
Revocation The patient has the right to revoke the DNR order at any time, either verbally or in writing, as long as they are capable of making such a decision.

How to Use Washington Do Not Resuscitate Order

Completing a Washington Do Not Resuscitate Order (DNR) form is a significant step in ensuring your healthcare preferences are respected. It allows individuals to communicate their wishes regarding resuscitation in a clear and legally recognized manner. Below are clear, step-by-step instructions for filling out the DNR form:

  1. Begin by downloading the official Washington Do Not Resuscitate Order form from a reliable source, such as a healthcare provider or state health department website.
  2. Fill in your full name as it appears on your identification documents. Ensure that the spelling is correct for legal purposes.
  3. Include your date of birth. This helps to confirm your identity.
  4. Provide your address, including city, state, and zip code, ensuring it is complete and up-to-date.
  5. Indicate your healthcare provider’s name and contact information. This should be someone familiar with your medical history and treatment preferences.
  6. In the designated section, clearly state your wishes regarding resuscitation. This is usually a check box or a written section where you can specify your preferences.
  7. Sign and date the form at the bottom. Your signature confirms that the information is accurate and that you understand the implications of your decision.
  8. Have a witness sign the form. Depending on Washington law, a witness may be required to verify your signature.
  9. Make copies of the completed form for yourself and your healthcare provider. Keep one copy in an easily accessible place.
  10. Consider discussing your decision with family members and caregivers to ensure everyone is aware of your wishes.

Key Facts about Washington Do Not Resuscitate Order

What is a Do Not Resuscitate (DNR) Order?

A Do Not Resuscitate Order (DNR) is a legal document that allows a person to refuse CPR and advanced cardiac life support in the event of a cardiac arrest. This order is intended for individuals who do not wish to receive life-saving measures in certain medical situations.

Who can request a DNR Order in Washington?

In Washington, any adult who has the capacity to make informed medical decisions can request a DNR Order. This includes individuals with terminal illnesses or those who are in a state where recovery is not expected.

How does one obtain a DNR Order in Washington?

To obtain a DNR Order, you must discuss your wishes with your healthcare provider. They will guide you through completing the official DNR form, which must be signed by you and your physician. This ensures that your preferences are documented and legally recognized.

Is a DNR Order limited to hospitals?

No, a DNR Order can apply in various settings beyond hospitals, including nursing homes and a person’s home. It's important that everyone involved in your care is aware of your order to ensure it is honored in any location.

What happens if a DNR Order is not honored?

If a DNR Order is not honored, it can lead to unwanted and distressing interventions. In such cases, family members or healthcare proxies may need to advocate for the individual's wishes. It is crucial to ensure that all healthcare providers are informed about the DNR status.

Can a DNR Order be revoked?

Yes, a DNR Order can be revoked at any time. The individual must clearly communicate their decision to withdraw the order, and healthcare providers should update their records accordingly. It's advisable to destroy any copies of the DNR Order to avoid confusion.

Does a DNR Order apply in all medical emergencies?

A DNR Order specifically applies to situations where resuscitation efforts are required, like cardiac arrest. It does not prevent other types of medical treatment, such as pain management or assistance for non-life-threatening conditions.

What should I do with my DNR Order after it is completed?

Once your DNR Order is completed, keep multiple copies accessible. It’s important to give a copy to your healthcare provider, family members, and anyone else involved in your medical care. This ensures that your wishes are respected in emergencies.

Can family members make a DNR decision if I cannot?

Yes, if you are unable to make decisions due to a medical condition, a legally designated healthcare proxy or family member may be able to make DNR decisions on your behalf. This should be discussed in advance to ensure alignment with your preferences.

How can I ensure my DNR Order is followed?

To ensure that your DNR Order is honored, communicate your wishes with your healthcare providers, family members, and caregivers. Consider discussing your health care plans in advance to confirm everyone understands your preferences.

Common mistakes

When filling out the Washington Do Not Resuscitate (DNR) Order form, mistakes can lead to confusion or complications in critical situations. One common error is failing to sign the document. A signature is essential to ensure that the order is valid and can be honored by medical personnel. Without it, healthcare providers may not recognize the wishes outlined in the form, potentially leading to unwanted resuscitation efforts.

Another frequent mistake involves incomplete information. Individuals often forget to provide essential details such as the patient’s full name, date of birth, or medical record number. Omitting this information can create ambiguity. Medical staff depend on accurate details to identify the patient, and missing information can hinder their ability to respect the DNR wishes during emergencies.

Confusion may arise from not discussing the DNR order with healthcare providers or family members. Many people assume that completing the form alone suffices. However, it is crucial to communicate the decision. This conversation ensures that everyone is on the same page and understands the patient's wishes. A lack of communication can lead to misunderstandings at critical moments.

Lastly, individuals might overlook updating the DNR order as life circumstances change. If a person’s health status alters or they receive new medical diagnoses, it may be necessary to revisit and renew the DNR order. Failing to do so risks having outdated directives in place. Regularly reviewing and updating the document helps ensure that it accurately reflects current intentions.

Documents used along the form

When preparing a comprehensive healthcare plan, several important documents complement the Washington Do Not Resuscitate (DNR) Order Form. These documents help individuals articulate their medical preferences and ensure their wishes are respected. Below is a list of commonly used forms and documents that work alongside the DNR order.

  • Advance Directive: This document allows individuals to specify their preferences for medical treatment should they become unable to communicate. It can include both a living will and a healthcare proxy, offering clarity on healthcare decisions.
  • Healthcare Power of Attorney: This legal form designates a trusted person to make healthcare decisions on someone’s behalf if they are incapacitated. The appointed individual acts according to the wishes of the person who created the document.
  • Living Will: Similar to an advance directive, a living will specifically addresses the types of medical treatments a person wishes to receive or decline in certain situations, such as terminal illness or irreversible coma.
  • Physician Orders for Life-Sustaining Treatment (POLST): The POLST form translates medical goals into actionable medical orders. It clarifies the desired level of care and is intended for individuals with serious health conditions who wish to be upfront about their treatment options.
  • Patient's Rights Document: This form outlines the rights patients have regarding their medical care, including the right to refuse treatment. Understanding these rights empowers individuals to advocate for themselves or their loved ones.
  • Do Not Hospitalize (DNH) Order: This form specifies the individual's preference to avoid hospitalization in certain circumstances, emphasizing comfort and quality of life rather than aggressive medical interventions.
  • End-of-Life Care Preferences: This document allows individuals to communicate their personal wishes regarding end-of-life care in more detail, addressing matters such as pain management and hospice services.

Incorporating these forms into healthcare planning can foster open discussions about life-support measures and preferences, promoting awareness and understanding among family members and healthcare providers. Each document plays a crucial role in ensuring that an individual's values and desires are honored in times of medical crisis.

Similar forms

A Do Not Resuscitate (DNR) Order form outlines a person's wish not to have CPR or other resuscitation methods used if their heart stops or they stop breathing. Several other documents serve similar purposes in healthcare decision-making. Here are seven of them:

  • Advance Directive: This legal document allows individuals to express their medical preferences in advance. It can include preferences on various treatments, not just resuscitation.
  • Living Will: A living will specifically addresses what types of medical treatment a person wishes to receive or not receive in the event they cannot communicate their wishes.
  • Healthcare Proxy: This document appoints someone to make healthcare decisions on behalf of an individual if they become unable to do so themselves.
  • Durable Power of Attorney for Health Care: Similar to a healthcare proxy, this document allows someone to make medical decisions for you, but it covers a broader range of situations.
  • No Code Order: This is another term for a DNR. It explicitly states that medical personnel should not perform resuscitation efforts if a patient's heart stops.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that outlines a patient's preferences for treatments, including resuscitation, ensuring that healthcare providers follow those wishes.
  • Do Not Intubate (DNI) Order: A DNI order is similar to a DNR but specifically states that a patient should not be placed on a ventilator, even if they are given other forms of treatment.

Dos and Don'ts

When completing a Washington Do Not Resuscitate (DNR) Order form, it is essential to approach the task carefully. This document holds significant weight in healthcare decisions. Here are a few important dos and don’ts to keep in mind:

  • Do ensure that the form is completed in black or blue ink for legibility.
  • Do provide your signature and the date where indicated.
  • Do include the name of the patient precisely as it appears on their legal documents.
  • Do discuss your wishes with your healthcare provider to ensure they align with your medical goals.
  • Do keep copies of the completed DNR Order for your records and provide copies to relevant parties, such as family members and healthcare providers.
  • Don’t fill out the form under pressure; take your time to consider all aspects of your decision.
  • Don’t leave any sections blank; incomplete forms may lead to confusion in critical situations.
  • Don’t disregard your advance directives, as these documents should align and support each other.
  • Don’t assume that the healthcare facility automatically has your DNR Order; ensure it is on file for easy access in emergencies.

By following these guidelines, individuals can more effectively communicate their healthcare wishes, ensuring they are respected when it matters most.

Misconceptions

The Washington Do Not Resuscitate (DNR) Order form is a critical document for individuals facing serious health issues. However, several misconceptions surround its use and implications. Understanding these misconceptions can provide clarity and help individuals make informed decisions regarding end-of-life care.

  • Misconception 1: A DNR order means no medical care will be provided.
  • Many people believe that having a DNR order in place means they will receive no medical attention at all. In reality, a DNR only affects resuscitation efforts in the event of cardiac or respiratory arrest. Other medical treatments, such as pain relief and comfort care, will still be administered.

  • Misconception 2: DNR orders are only for terminally ill patients.
  • Some individuals think that DNR orders apply solely to those with terminal illnesses. However, a DNR can be appropriate for anyone who wishes to avoid resuscitation in the event of a health crisis, regardless of their current health status.

  • Misconception 3: DNR orders cannot be revoked.
  • This misconception persists among many. In fact, patients can revoke or modify their DNR orders at any time, as long as they are capable of making their own healthcare decisions. Changes can often be made verbally, but it’s best to document them formally.

  • Misconception 4: Healthcare providers automatically know my wishes.
  • Assumptions are made that healthcare providers will always know a patient's preferences regarding resuscitation. To avoid confusion, it is essential to have a written DNR order, which ensures that medical personnel are aware of and respect the patient’s wishes.

  • Misconception 5: DNR orders apply to all medical situations.
  • People may think that a DNR order covers all healthcare decisions. However, it specifically pertains to situations where the heart or breathing stops. Other healthcare decisions, such as treatment for serious illness or surgery, are not covered by a DNR and must be addressed separately through other advance healthcare directives.

  • Misconception 6: DNR orders are only relevant in hospitals.
  • Some assume that DNR orders only matter within hospital settings. In truth, DNR orders are recognized in various environments, including homes, nursing facilities, and other care settings. It is important to make sure that family members and caregivers are aware of the DNR order and understand its implications.

Key takeaways

Here are key takeaways regarding the Washington Do Not Resuscitate (DNR) Order form:

  • A Do Not Resuscitate Order allows individuals to refuse resuscitation efforts in case of cardiac arrest or respiratory failure.
  • The form must be signed by a physician, along with the patient or their legal representative.
  • In Washington, a DNR form is honored across various healthcare settings, including hospitals and emergency medical services.
  • The DNR order must be prominently displayed in the patient's medical record and easily accessible to healthcare providers.
  • Individuals can revoke their DNR order at any time, typically by destroying the original form and notifying their healthcare providers.
  • Family members should be informed about the DNR order so they understand the patient’s wishes.
  • The DNR order is specific to resuscitation; it does not affect other medical treatments the patient may wish to receive.
  • It is advisable to review the DNR order periodically, especially if the patient’s health status changes.