Printable PDF Forms
Homepage ⇉ Blank Do Not Resuscitate Order Form ⇉ Pennsylvania Do Not Resuscitate Order Document
Contents

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 emergency situations. This legally binding document allows patients to indicate their desire not to receive cardiopulmonary resuscitation (CPR) if their heart stops beating or if they stop breathing. The form is designed to be straightforward, enabling patients, their families, and healthcare providers to understand and respect the patient's preferences. It includes essential details such as the patient’s name, date of birth, and signature, along with the signatures of witnesses or a healthcare representative. Importantly, the DNR Order must be readily accessible, often kept in a visible location, such as on the refrigerator or in a medical file, to ensure that emergency responders can quickly identify it when necessary. By completing this form, individuals can take an active role in their end-of-life care, alleviating the burden on loved ones and healthcare professionals during critical moments.

Discover More Do Not Resuscitate Order Forms for Different States

Does a Dnr Need to Be Signed by a Doctor - Person-centered care values the patient's dignity, and a DNR Order plays a role in this approach.

When engaging in the transfer of a dirt bike in New York, it is crucial to utilize the New York Dirt Bike Bill of Sale form to facilitate the transaction. This document not only outlines the necessary information regarding the seller, buyer, and bike specifications, but it also aids in safeguarding the rights of both parties. For more resources regarding this form, you can visit https://freebusinessforms.org.

Dnrcc Meaning - Some patients may choose to have a "No Code" status rather than a formal DNR order.

Similar forms

  • Living Will: A living will outlines your wishes regarding medical treatment in situations where you cannot communicate. Like a DNR, it provides guidance on life-sustaining measures.
  • Health Care Proxy: This document allows you to appoint someone to make medical decisions on your behalf if you are unable to do so. It complements a DNR by ensuring your wishes are respected.
  • Advance Directive: An advance directive combines both a living will and a health care proxy. It details your medical preferences and designates a decision-maker, similar to the DNR’s intent.
  • Power of Attorney for Health Care: This legal document grants someone authority to make health care decisions for you. It aligns with a DNR by ensuring your health care preferences are honored.

  • Arizona Trailer Bill of Sale: The Arizona Trailer Bill of Sale form serves as a legal document that records the sale and purchase of a trailer in Arizona, providing essential proof of ownership and transaction details for registration. For further information, read more about the document.

  • Physician Orders for Life-Sustaining Treatment (POLST): POLST translates your wishes into actionable medical orders. It is similar to a DNR in that it specifies the types of treatment you want or do not want.
  • Do Not Intubate (DNI) Order: A DNI order specifically instructs medical staff not to insert a breathing tube. It focuses on respiratory support, much like a DNR focuses on resuscitation.
  • Comfort Care Order: This document emphasizes the importance of comfort over aggressive treatment. It aligns with the intent of a DNR by prioritizing quality of life at the end stage.
  • Emergency Medical Services (EMS) Do Not Resuscitate Form: Similar to a DNR, this form is recognized by EMS personnel to avoid resuscitation efforts in emergencies.
  • Medical Treatment Preferences: This document allows you to express your preferences for various medical treatments. It serves a similar purpose as a DNR by guiding care decisions.
  • End-of-Life Care Plan: This plan outlines your wishes for care at the end of life. It complements a DNR by ensuring that your overall preferences for care are understood and respected.

Document Example

Pennsylvania Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order is made in accordance with the Pennsylvania law, specifically Act 169 of 2006. This document allows an individual to request that CPR and other resuscitation measures not be performed in the event of cardiac or respiratory arrest.

Please fill out the information below:

  • Patient's Full Name: ___________________________
  • Date of Birth: ___________________________
  • Address: ___________________________
  • City: ___________________________
  • State: ___________________________
  • Zip Code: ___________________________

I, the undersigned, understand the implications of this Do Not Resuscitate Order. I hereby direct that, in the event of my cardiac or respiratory arrest, all resuscitation efforts shall be withheld.

Signature of Patient: ___________________________

Date: ___________________________

Witness Information

This order must be signed by a witness who is not related to the patient and who will not inherit anything from them.

  • Witness's Full Name: ___________________________
  • Address: ___________________________
  • City: ___________________________
  • State: ___________________________
  • Zip Code: ___________________________

Signature of Witness: ___________________________

Date: ___________________________

It is recommended to keep a copy of this DNR Order in a visible location and to provide copies to your healthcare providers and emergency contacts.

PDF Form Specs

Fact Name Details
Purpose The Pennsylvania Do Not Resuscitate Order form allows individuals to refuse resuscitation in the event of cardiac or respiratory arrest.
Governing Law This form is governed by the Pennsylvania Consolidated Statutes, Title 20, Chapter 54.
Eligibility Any adult who is competent to make medical decisions may complete this form.
Signature Requirements The form must be signed by the individual and a witness or a healthcare provider to be valid.

Crucial Questions on This Form

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

A Do Not Resuscitate Order is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops beating or if they stop breathing. In Pennsylvania, this order is legally recognized and can be crucial for individuals who wish to avoid aggressive medical interventions at the end of life.

Who can request a DNR Order?

A DNR Order can be requested by a patient who is at least 18 years old and has the capacity to make healthcare decisions. If the patient is unable to make such decisions, a legally authorized representative, such as a family member or designated healthcare proxy, may request the order on their behalf.

How is a DNR Order created in Pennsylvania?

To create a DNR Order in Pennsylvania, the following steps are typically involved:

  1. The patient or their representative must discuss their wishes with a physician.
  2. The physician must evaluate the patient’s medical condition and determine if a DNR Order is appropriate.
  3. If appropriate, the physician will complete and sign the DNR Order form, which must include specific information such as the patient's name and the physician's details.

What does the DNR Order form look like?

The DNR Order form in Pennsylvania is a standardized document that includes sections for patient information, physician details, and signatures. It is typically printed on bright pink paper to ensure visibility and recognition by emergency medical personnel. The form should be kept in a location that is easily accessible, such as on the refrigerator or with the patient's medical records.

Can a DNR Order be revoked?

Yes, a DNR Order can be revoked at any time by the patient or their legal representative. To revoke the order, the patient or representative must communicate their wishes clearly to their healthcare provider. It is advisable to document the revocation in writing to avoid any confusion in emergency situations.

What should family members know about a DNR Order?

Family members should be informed about the existence of a DNR Order and its implications. Open communication is essential. They should understand that a DNR Order does not mean that all medical treatment will cease; it specifically pertains to resuscitation efforts. Family members may also want to discuss end-of-life wishes and preferences with the patient to ensure everyone is on the same page.

Where can I obtain a DNR Order form in Pennsylvania?

A DNR Order form can be obtained from various sources, including:

  • Your healthcare provider or physician's office
  • Local hospitals or healthcare facilities
  • The Pennsylvania Department of Health website

It is important to ensure that the form is the most current version and complies with state regulations.

Documents used along the form

When considering a Do Not Resuscitate (DNR) Order in Pennsylvania, it is essential to understand that several other documents may complement or support this directive. Each document plays a unique role in ensuring that your healthcare preferences are respected and clearly communicated to medical professionals. Below is a list of forms and documents often used alongside a DNR Order.

  • Advance Healthcare Directive: This document allows individuals to outline their healthcare preferences in advance. It includes instructions on medical treatment and appoints a healthcare agent to make decisions if the individual becomes unable to do so.
  • Durable Power of Attorney for Healthcare: This form designates a trusted person to make healthcare decisions on your behalf if you are incapacitated. It can provide clarity on your wishes and ensure they are honored.
  • Living Will: A living will specifies the types of medical treatment you do or do not want in certain situations, such as terminal illness or irreversible coma. It serves as a guide for healthcare providers and family members.
  • Quitclaim Deed Form: When transferring property ownership, make use of our comprehensive Quitclaim Deed guidelines to ensure clarity and legal compliance.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that outlines a patient’s preferences for life-sustaining treatment. It is typically used for individuals with serious health conditions and is recognized by healthcare providers.
  • Healthcare Proxy: Similar to a durable power of attorney, a healthcare proxy is a person appointed to make medical decisions when you cannot. This document ensures that someone you trust advocates for your care.
  • Patient Bill of Rights: This document informs patients of their rights regarding medical treatment and care. Understanding these rights can empower individuals to make informed decisions about their healthcare.
  • Organ Donation Consent: If you wish to donate your organs after death, this form indicates your consent. It can be included with your DNR Order to clarify your wishes regarding organ donation.

Having these documents in place can provide peace of mind and ensure that your healthcare preferences are respected. It is advisable to discuss these options with family members and healthcare providers to create a comprehensive plan that reflects your wishes.

Misconceptions

When it comes to the Pennsylvania Do Not Resuscitate (DNR) Order form, there are several common misconceptions that can lead to confusion. Understanding these misconceptions can help ensure that individuals make informed decisions about their healthcare preferences.

  • A DNR order means that no medical care will be provided. This is not true. A DNR order specifically instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest. However, it does not prevent other types of medical treatment or care from being administered. Patients will continue to receive appropriate medical care to manage their conditions.
  • Only terminally ill patients need a DNR order. This is a misconception. While many people who choose a DNR order may be facing terminal illnesses, anyone can request a DNR if they feel it aligns with their personal healthcare wishes. It’s a personal decision that reflects an individual's values and preferences regarding end-of-life care.
  • A DNR order is permanent and cannot be changed. This is incorrect. A DNR order can be revoked or modified at any time by the patient or their legal representative. If circumstances change or if the patient’s wishes evolve, they can easily update their DNR status.
  • Healthcare providers will not respect a DNR order outside of a hospital setting. This is a common misunderstanding. In Pennsylvania, a properly completed DNR order is valid in various settings, including at home, in nursing facilities, and during emergency medical services. First responders are trained to recognize and honor valid DNR orders, ensuring that patients’ wishes are respected regardless of the location.