Free Pennsylvania Do Not Resuscitate Order Template Get Document Here

Free Pennsylvania Do Not Resuscitate Order Template

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 is crucial for ensuring that a person's preferences about life-sustaining treatment are respected by healthcare providers. To take control of your healthcare decisions, consider filling out the DNR form by clicking the button below.

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Key takeaways

Understanding the Pennsylvania Do Not Resuscitate (DNR) Order form is crucial for ensuring that your healthcare preferences are respected. 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 your heart stops or you stop breathing.
  • It is essential to have a conversation with your healthcare provider before completing the form to ensure that your wishes are clearly understood.
  • The form must be signed by a physician to be valid. This ensures that your decision is backed by medical guidance.
  • You have the right to revoke or change your DNR Order at any time. Inform your healthcare provider and any relevant parties about any updates.
  • The DNR Order should be kept in an easily accessible location, such as on your refrigerator or with your medical records, so that emergency responders can quickly find it.
  • It is advisable to inform family members and close friends about your DNR Order to prevent confusion during a medical emergency.
  • Be aware that the DNR Order only applies to resuscitation efforts. It does not affect other medical treatments you may wish to receive.

By understanding these key points, you can make informed decisions regarding your healthcare preferences and ensure they are honored when it matters most.

Dos and Don'ts

When filling out the Pennsylvania Do Not Resuscitate (DNR) Order form, it is essential to approach the process with care and consideration. Below is a list of important dos and don'ts to keep in mind.

  • Do ensure that you understand what a DNR order entails before completing the form.
  • Do discuss your wishes with your healthcare provider and family members.
  • Do fill out the form completely and accurately, including all required signatures.
  • Do keep a copy of the completed DNR order in a safe and accessible place.
  • Do review your DNR order periodically to ensure it still reflects your wishes.
  • Don't rush through the form without understanding its implications.
  • Don't assume that verbal instructions are sufficient; written documentation is necessary.
  • Don't forget to inform your healthcare team about your DNR order.
  • Don't disregard the importance of discussing your decision with loved ones.

By following these guidelines, you can ensure that your wishes regarding resuscitation are clearly communicated and respected. Taking the time to fill out the DNR order thoughtfully can provide peace of mind for you and your family.

PDF Characteristics

Fact Name Description
Governing Law The Pennsylvania Do Not Resuscitate Order is governed by the Pennsylvania Consolidated Statutes, Title 20, Chapter 54.
Purpose This form allows individuals to refuse resuscitation in the event of cardiac or respiratory arrest.
Eligibility Any adult who is capable of making health care decisions can complete the DNR order.
Signature Requirement The form must be signed by the individual or their authorized representative.
Witness Requirement The signature must be witnessed by two individuals, who are not related to the individual or beneficiaries of their estate.
Health Care Provider A licensed physician must sign the DNR order for it to be valid.
Revocation The DNR order can be revoked at any time by the individual or their representative.
Location The completed form should be kept in a location that is easily accessible to emergency medical personnel.
Interstate Recognition Other states may not recognize Pennsylvania's DNR order; individuals should check local laws when traveling.

Common mistakes

  1. Inaccurate Personal Information: Failing to provide complete and accurate personal details can lead to confusion. This includes not listing the correct name, date of birth, or address.

  2. Missing Signatures: The form requires signatures from both the patient and the physician. Omitting either signature renders the document invalid.

  3. Not Understanding the Implications: Some individuals do not fully grasp what a Do Not Resuscitate Order entails. It is essential to understand that this decision affects emergency medical treatment.

  4. Failure to Communicate: Not discussing the decision with family members or healthcare providers can lead to misunderstandings. Open communication ensures everyone is aware of the patient's wishes.

  5. Not Updating the Form: Life circumstances change, and so do medical preferences. Failing to update the DNR form when there are changes in health status or personal wishes can lead to unintended outcomes.

Similar forms

The Advance Directive is a document that allows individuals to outline their healthcare preferences in case they become unable to communicate their wishes. Like the Do Not Resuscitate Order (DNR), it provides guidance to medical professionals about the type of care a person wants or does not want. An Advance Directive can include specific instructions about life-sustaining treatments, making it a comprehensive tool for managing end-of-life care.

The Living Will is another important document that shares similarities with the DNR. It specifically details a person's wishes regarding medical treatment in situations where they cannot express their preferences. This document often addresses scenarios such as terminal illness or irreversible coma, providing clarity on the individual's choices about life support and other medical interventions.

The Medical Power of Attorney allows a person to designate someone else to make healthcare decisions on their behalf if they are unable to do so. This document is similar to the DNR in that it emphasizes the importance of respecting a person's wishes regarding medical treatment. The appointed individual can make choices consistent with the person's values and preferences, including decisions about resuscitation efforts.

The New York Boat Bill of Sale form is a legal document used to transfer ownership of a boat from one party to another. This form includes essential details such as the buyer's and seller's information, a description of the boat, and the sale price. Completing this document ensures that the transaction is recorded properly and protects the interests of both parties involved, making it crucial to utilize resources such as NY PDF Forms for accurate and reliable documentation.

The Physician Orders for Life-Sustaining Treatment (POLST) form is used to communicate a patient's preferences for life-sustaining treatments in a more detailed manner. Like the DNR, it is a medical order signed by a physician and is intended for individuals with serious health conditions. The POLST form outlines specific treatments the patient does or does not want, making it an effective tool for ensuring that their wishes are honored in medical emergencies.

The Comfort Care Order focuses on providing relief from pain and other distressing symptoms rather than prolonging life. Similar to the DNR, it emphasizes a person's desire for comfort rather than aggressive medical interventions. This document guides healthcare providers in delivering care that aligns with the patient's wishes, especially in end-of-life situations.

The Do Not Intubate (DNI) order is closely related to the DNR. It specifically states that a patient does not wish to be placed on a ventilator if they are unable to breathe on their own. Like the DNR, the DNI order serves to communicate a patient's preferences regarding life-sustaining measures, ensuring that their choices about respiratory support are respected during medical emergencies.

Discover Some Other Do Not Resuscitate Order Templates for Different States

Your Questions, Answered

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

A Do Not Resuscitate Order is a legal document that allows individuals to refuse certain medical treatments in the event of a medical emergency. Specifically, it instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if the individual stops breathing or their heart stops beating. In Pennsylvania, this order is intended to respect the wishes of patients who may not want aggressive life-saving measures taken in situations where recovery is unlikely.

Who can request a DNR Order in Pennsylvania?

In Pennsylvania, a DNR Order can be requested by a competent adult. If the individual is unable to make their own medical decisions, a legally authorized representative, such as a family member or designated healthcare proxy, can request the order on their behalf. It is important that the request reflects the individual's wishes regarding end-of-life care.

How do I obtain a DNR Order in Pennsylvania?

To obtain a DNR Order in Pennsylvania, follow these steps:

  1. Consult with your healthcare provider. Discuss your wishes regarding resuscitation and end-of-life care.
  2. If appropriate, your healthcare provider will help you complete the Pennsylvania DNR Order form.
  3. Ensure that the form is signed by both you (or your representative) and your physician.
  4. Keep copies of the signed DNR Order in easily accessible places, such as with your medical records or in your home.

What should I do if my DNR Order is not being honored?

If you find that your DNR Order is not being honored, it is crucial to address the situation immediately. Here are some steps to take:

  • Communicate clearly with the healthcare team. Share your DNR Order and explain your wishes.
  • Request to speak with a supervisor or an ethics committee if your concerns are not resolved.
  • Consider reaching out to an attorney who specializes in healthcare law if issues persist.

It is essential that your wishes are respected, and taking these steps can help ensure that happens.

Form Preview

Pennsylvania Do Not Resuscitate Order (DNR)

This form serves as a legally recognized Do Not Resuscitate (DNR) order under Pennsylvania law. By completing this document, you declare your wishes regarding medical resuscitation in the event of a cardiac arrest or respiratory failure.

Patient Information:

  • Name: ______________________________
  • Date of Birth: _______________________
  • Address: _____________________________
  • City: ________________________________
  • State: Pennsylvania
  • Zip Code: __________________________

Healthcare Agent Information (if applicable):

  • Name: ______________________________
  • Phone Number: ______________________
  • Relationship: ________________________

Statement of Wishes:

I hereby state that, in the event my heart stops beating or I stop breathing, I do not want resuscitation efforts to be initiated. This includes, but is not limited to, cardiopulmonary resuscitation (CPR), intubation, and advanced life support.

Signature of Patient or Authorized Agent:

  • Signature: ____________________________
  • Date: _________________________________

Witness Information:

  • Name: ______________________________
  • Signature: ___________________________
  • Date: _________________________________

This DNR order should be prominently displayed in your medical records and shared with your healthcare provider. For further information, please consult Pennsylvania Act 169 of 2006 and other applicable state laws regarding advance directives and end-of-life care.