Attorney-Approved Wisconsin Do Not Resuscitate Order Document

Attorney-Approved Wisconsin Do Not Resuscitate Order Document

A Wisconsin Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to refuse resuscitation efforts in the event of a cardiac or respiratory arrest. This form ensures that medical personnel respect the wishes of patients who prefer to avoid life-saving measures. If you or a loved one are considering this option, it is crucial to fill out the form accurately and promptly.

Take action now by filling out the form below to ensure your healthcare preferences are known.

Article Guide

The Wisconsin Do Not Resuscitate (DNR) Order form serves as a critical tool for individuals wishing to express their preferences regarding medical treatment in emergency situations. This legally binding document enables patients to communicate their desire to forgo resuscitation efforts in the event of cardiac arrest or respiratory failure. Designed to ensure that healthcare providers respect a patient’s wishes, the DNR form must be completed and signed by both the patient and their physician. It is essential for individuals to understand the implications of this order, as it can significantly impact the course of medical care. Additionally, the form must be readily accessible to emergency responders, ensuring that the patient’s wishes are honored at all times. In Wisconsin, the DNR Order is part of a broader conversation about end-of-life care and patient autonomy, reflecting the importance of informed decision-making in healthcare settings.

Wisconsin Do Not Resuscitate Order Preview

Wisconsin Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is created in accordance with Wisconsin state laws governing advance directives and medical decisions. It allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency.

Please complete the following information:

  • Patient Name: _______________________________
  • Date of Birth: _______________________________
  • Address: _____________________________________
  • City, State, Zip Code: ______________________
  • Phone Number: ______________________________

By signing this document, I declare my wishes regarding resuscitation as follows:

  1. I do not wish to receive cardiopulmonary resuscitation (CPR) or other resuscitative measures if my heart stops beating or if I stop breathing.
  2. I understand that this order will be honored by all medical personnel and facilities in Wisconsin.
  3. This order is effective immediately upon signing and will remain in effect until revoked or modified by me.

Signature of Patient: _______________________________

Date: _____________________________________________

If the patient is unable to sign, the following section should be completed by a legally authorized representative:

  • Representative Name: ____________________________
  • Relationship to Patient: ________________________
  • Signature of Representative: _____________________
  • Date: ________________________________________

It is recommended to provide copies of this DNR Order to your healthcare providers, family members, and keep a copy for your records. Your wishes should be respected and honored in any medical situation.

Form Attributes

Fact Name Description
Purpose The Wisconsin Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation efforts in case of cardiac or respiratory arrest.
Eligibility Any adult who is capable of making health care decisions can complete a DNR order, or it can be completed by a legal representative on behalf of an incapacitated individual.
Governing Law The DNR Order in Wisconsin is governed by Wisconsin Statutes § 154.03 and § 154.10.
Signature Requirement The form must be signed by the individual or their authorized representative, as well as a physician who agrees to the order.
Validity A properly completed DNR order is valid throughout the state of Wisconsin and must be honored by all emergency medical personnel and healthcare providers.

How to Use Wisconsin Do Not Resuscitate Order

Filling out the Wisconsin Do Not Resuscitate Order form is a straightforward process that allows individuals to communicate their wishes regarding medical treatment in emergency situations. Once the form is completed, it should be shared with healthcare providers and family members to ensure that everyone is aware of your preferences.

  1. Obtain the Wisconsin Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
  2. Fill in your full name, date of birth, and address at the top of the form.
  3. Indicate your decision regarding resuscitation by checking the appropriate box. Make sure to read the options carefully.
  4. Provide the name and contact information of your primary physician. This ensures that your healthcare provider is aware of your wishes.
  5. Sign and date the form. Your signature confirms that you understand the implications of your decision.
  6. Have a witness sign the form. This can be anyone who is not related to you or a healthcare provider involved in your care.
  7. Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and family members.

After completing the form, it’s essential to discuss your wishes with loved ones and healthcare professionals. Open conversations can help ensure that your preferences are respected and understood in times of need.

Key Facts about Wisconsin Do Not Resuscitate Order

What is a Do Not Resuscitate (DNR) Order in Wisconsin?

A Do Not Resuscitate Order is a legal document that allows a person to refuse resuscitation efforts in the event of a cardiac arrest or respiratory failure. In Wisconsin, this order is recognized by healthcare providers and is intended to honor the wishes of individuals regarding their end-of-life care.

Who can complete a DNR Order in Wisconsin?

A DNR Order can be completed by any adult who is capable of making their own medical decisions. This includes individuals who are 18 years or older and understand the implications of the order. Additionally, a healthcare provider must sign the form to validate it.

How do I obtain a DNR Order form in Wisconsin?

You can obtain a DNR Order form from various sources, including hospitals, healthcare providers, or online through the Wisconsin Department of Health Services website. Ensure that you use the official form to avoid any complications.

What information is required on the DNR Order form?

The form requires personal information such as the individual's name, date of birth, and address. It also includes sections for the signature of the individual and their healthcare provider, as well as a statement of the individual's wishes regarding resuscitation.

Is a DNR Order valid in all healthcare settings?

Yes, a properly completed and signed DNR Order is valid in all healthcare settings in Wisconsin. This includes hospitals, nursing homes, and home healthcare situations. It is important to ensure that the order is readily available to healthcare providers when needed.

Can I change or revoke my DNR Order?

Yes, you can change or revoke your DNR Order at any time. To do so, you should notify your healthcare provider and complete a new DNR Order form if necessary. It is advisable to destroy any previous versions to avoid confusion.

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

Once completed, keep the DNR Order in a safe but accessible location. It should be easily available to your healthcare providers, family members, and caregivers. Consider carrying a copy with you if you are traveling or attending medical appointments.

Will my family be informed about my DNR Order?

It is essential to discuss your DNR Order with your family and loved ones. This ensures they understand your wishes and can advocate for you if necessary. Clear communication can help prevent misunderstandings during critical moments.

What happens if I do not have a DNR Order?

If you do not have a DNR Order in place, healthcare providers will typically perform all resuscitation efforts in the event of a cardiac arrest or respiratory failure. This is standard practice unless otherwise indicated through a valid DNR Order.

Where can I find more information about DNR Orders in Wisconsin?

For more information, you can visit the Wisconsin Department of Health Services website or consult with your healthcare provider. They can provide guidance on completing a DNR Order and answer any additional questions you may have.

Common mistakes

Filling out the Wisconsin Do Not Resuscitate (DNR) Order form is a critical step for individuals who wish to express their preferences regarding emergency medical treatment. However, several common mistakes can lead to confusion or unintended consequences. Understanding these pitfalls can help ensure that the form accurately reflects one’s wishes.

One frequent mistake is failing to provide the necessary personal information. Individuals must include their full name, date of birth, and address. Omitting any of this information can lead to issues with the form’s validity. Incomplete forms may be disregarded by medical personnel, potentially resulting in unwanted resuscitation.

Another common error is not having the form signed by the appropriate parties. The Wisconsin DNR Order must be signed by the patient or their legal representative. If the signature is missing, medical professionals may not recognize the document as valid. This oversight can cause significant distress during critical moments.

Some people mistakenly believe that a DNR Order is only valid if witnessed. While having witnesses can be beneficial, it is not a requirement in Wisconsin. However, failing to follow the proper signing procedures can still invalidate the form. It is essential to ensure that all signatures are in place and correctly executed.

Misunderstanding the scope of the DNR Order is another common mistake. The form specifically addresses resuscitation efforts in the event of cardiac or respiratory arrest. Some individuals may erroneously assume that a DNR Order applies to all medical interventions, which is not the case. Clarifying this distinction is crucial for ensuring that the document aligns with one’s healthcare preferences.

Moreover, individuals often neglect to discuss their DNR Order with family members or healthcare providers. Open communication is vital to ensure that loved ones understand the individual’s wishes. Without this dialogue, family members may feel uncertain or conflicted about the decision during a medical crisis.

Another oversight is failing to review and update the DNR Order regularly. Life circumstances change, and preferences may evolve over time. It is important to revisit the document periodically to ensure that it still reflects current wishes and to make any necessary adjustments.

Some individuals may also overlook the importance of keeping the DNR Order accessible. It should be stored in a location where it can be easily retrieved in an emergency. If medical personnel cannot locate the document quickly, the individual’s wishes may not be honored.

Additionally, people sometimes fill out the form without fully understanding its implications. It is advisable to seek guidance from healthcare professionals or legal advisors to ensure that the DNR Order is filled out correctly and that all aspects are comprehended.

Finally, failing to provide copies of the DNR Order to relevant parties can lead to complications. It is essential to distribute copies to healthcare providers, family members, and any other individuals involved in the individual’s care. This proactive approach ensures that everyone is aware of the patient’s preferences.

By avoiding these common mistakes, individuals can ensure that their Wisconsin Do Not Resuscitate Order accurately reflects their wishes, providing clarity and peace of mind for themselves and their loved ones.

Documents used along the form

When considering end-of-life care options, individuals and families often encounter various documents that work in conjunction with the Wisconsin Do Not Resuscitate Order (DNR) form. These documents help clarify healthcare preferences and ensure that wishes are respected. Below is a list of commonly used forms and documents that may accompany a DNR order.

  • Living Will: This document outlines an individual's wishes regarding medical treatment in situations where they are unable to communicate their preferences. It typically addresses life-sustaining treatments and other critical care decisions.
  • Durable Power of Attorney for Health Care: This legal document allows an individual to designate someone to make healthcare decisions on their behalf if they become incapacitated. It is essential for ensuring that a trusted person can advocate for one's medical preferences.
  • Physician Orders for Life-Sustaining Treatment (POLST): The POLST form translates a patient’s preferences regarding life-sustaining treatments into actionable medical orders. It is particularly useful for those with serious health conditions.
  • Advance Directive: An advance directive encompasses both a living will and a durable power of attorney for health care. It serves as a comprehensive guide for healthcare providers regarding a person's wishes.
  • Healthcare Proxy: This document designates a person to make medical decisions on behalf of someone who is unable to do so. It is similar to a durable power of attorney but focuses specifically on healthcare decisions.
  • Do Not Intubate (DNI) Order: This order specifically instructs healthcare providers not to perform intubation or mechanical ventilation in the event of respiratory failure. It complements a DNR order by addressing breathing support.
  • Organ Donation Consent: This document expresses an individual's wishes regarding organ donation after death. It is crucial for ensuring that one's intentions are honored and can alleviate the burden on family members during a difficult time.
  • Emergency Medical Services (EMS) Bracelet or Card: This identification serves as a quick reference for first responders, indicating the presence of a DNR order or other medical preferences. It ensures that wishes are respected in emergency situations.
  • Patient Advocate or Ombudsman Information: While not a formal document, having access to a patient advocate or ombudsman can provide support in navigating healthcare decisions and ensuring that patient rights are upheld.

Understanding these documents can empower individuals to make informed decisions about their healthcare. By preparing these forms, you can ensure that your values and wishes are honored, providing peace of mind for you and your loved ones during challenging times.

Similar forms

  • Advance Healthcare Directive: This document allows individuals to outline their healthcare preferences in advance, similar to a DNR. It can specify the types of medical treatment a person wishes to receive or refuse in case they become unable to communicate their wishes.
  • Living Will: A living will is a specific type of advance directive. It provides guidance on medical treatment preferences, particularly regarding end-of-life care. Like a DNR, it communicates a person's wishes when they cannot speak for themselves.
  • Healthcare Power of Attorney: This document designates someone to make medical decisions on behalf of an individual if they become incapacitated. While a DNR focuses on resuscitation preferences, a healthcare power of attorney encompasses broader medical decisions.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST forms are medical orders that detail a patient's preferences for treatment, including resuscitation efforts. Similar to a DNR, they are intended for individuals with serious illnesses who wish to ensure their wishes are honored in emergencies.
  • Do Not Intubate Order: This order specifies that a patient should not be placed on a ventilator if they are unable to breathe on their own. Like a DNR, it reflects the patient's wishes regarding life-sustaining measures, particularly in critical situations.

Dos and Don'ts

When filling out the Wisconsin Do Not Resuscitate (DNR) Order form, it's essential to approach the process with care. Here’s a helpful list of things to do and avoid:

  • Do ensure that you understand the implications of a DNR order. This decision can have significant effects on medical care.
  • Do discuss your wishes with your healthcare provider. They can provide valuable guidance and support.
  • Do have a conversation with family members or loved ones. Make sure they understand your wishes and the reasons behind them.
  • Do fill out the form completely and accurately. Every detail matters to ensure your wishes are honored.
  • Don’t rush the process. Take your time to think through your decisions and their potential outcomes.
  • Don’t assume that verbal agreements are enough. A signed form is necessary for your wishes to be legally recognized.
  • Don’t forget to keep copies of the completed form. Share them with your healthcare provider and family.
  • Don’t hesitate to ask questions. If you’re unsure about anything, seek clarification before finalizing the form.

By following these guidelines, you can ensure that your DNR order reflects your wishes and provides clarity for your healthcare providers and loved ones.

Misconceptions

Misconceptions about the Wisconsin Do Not Resuscitate (DNR) Order form can lead to confusion and unintended consequences for patients and their families. Below are five common misconceptions, along with explanations to clarify them.

  • Misconception 1: A DNR order means that no medical care will be provided.
  • This is false. A DNR order specifically pertains to the withholding of cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. Other medical treatments and interventions will still be provided as needed.

  • Misconception 2: A DNR order is only for terminally ill patients.
  • This is not accurate. While many individuals who choose a DNR may be facing serious health issues, anyone can request a DNR order regardless of their diagnosis or prognosis.

  • Misconception 3: A DNR order is permanent and cannot be changed.
  • This is incorrect. A DNR order can be revoked at any time by the patient or their authorized representative. It is important for individuals to communicate their wishes clearly to their healthcare providers.

  • Misconception 4: A DNR order is automatically recognized in all healthcare settings.
  • This statement is misleading. While Wisconsin law recognizes DNR orders, it is crucial for individuals to ensure that their DNR is documented properly and communicated to all healthcare providers involved in their care.

  • Misconception 5: A DNR order only applies in hospitals.
  • This is not true. A DNR order is valid in various settings, including at home or in long-term care facilities, provided that it is appropriately documented and recognized by the healthcare team.

Key takeaways

Filling out and using the Wisconsin Do Not Resuscitate (DNR) Order form is an important step for individuals who wish to express their healthcare preferences. Here are some key takeaways to consider:

  • The DNR Order form allows individuals to refuse resuscitation in the event of cardiac or respiratory arrest.
  • It is crucial to have the form signed by a physician to ensure it is valid.
  • Patients must be competent to make decisions about their medical care when completing the form.
  • Make sure to provide copies of the signed DNR Order to all relevant healthcare providers.
  • Keep the original form in an easily accessible location, such as with other important medical documents.
  • Review the DNR Order regularly, especially if there are changes in health status or treatment preferences.
  • Communicate your wishes clearly with family members and caregivers to avoid confusion in emergency situations.

Understanding these points can help ensure that your healthcare preferences are respected and followed. Always consult with healthcare professionals if you have questions about the process.