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Example - Delaware Do Not Resuscitate Order Form
Delaware Do Not Resuscitate Order
This Do Not Resuscitate (DNR) Order is created in accordance with the Delaware Health Care Decisions Act.
Please fill in the following information:
- Patient Name: ____________________________
- Date of Birth: ____________________________
- Address: ________________________________
- City, State, Zip Code: _________________
- Patient's Healthcare Representative Name: ____________________________
- Healthcare Representative Phone Number: ____________________________
This order indicates that the patient does not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
By signing below, you acknowledge the following:
- This DNR Order is valid and reflects my wishes.
- It may be presented to healthcare providers at any time.
- I can revoke this order at any time, and it will become void if I do so.
Patient Signature: ____________________________
Date: ____________________________
Healthcare Representative Signature: ____________________________
Date: ____________________________
This DNR order will remain in effect until modified or revoked in writing. Make sure to keep copies of this document in accessible locations.
Delaware Do Not Resuscitate Order: Usage Guide
Filling out the Delaware Do Not Resuscitate Order form is an important step in expressing your medical preferences. This form allows you to communicate your wishes clearly and ensures that your healthcare providers understand your choices. Here’s how to complete the form effectively.
- Obtain the Delaware Do Not Resuscitate Order form. You can usually find it on the Delaware Division of Public Health website or through your healthcare provider.
- Carefully read the instructions provided with the form to understand the requirements.
- Fill in your personal information, including your full name, date of birth, and address. Make sure this information is accurate.
- Indicate your decision regarding resuscitation by checking the appropriate box on the form.
- Sign and date the form. Your signature is crucial as it validates your wishes.
- Have a witness sign the form. This witness should be someone who is not a family member or your healthcare provider.
- Make copies of the completed form for your records and share it with your healthcare provider and family members.
Once you’ve filled out the form, it’s essential to keep it in a safe but accessible place. Ensure that your healthcare team is aware of your wishes by providing them with a copy. Open conversations with your loved ones about your choices can also help them understand your preferences better.
Documents used along the form
The Delaware Do Not Resuscitate (DNR) Order form is an essential document for individuals wishing to express their preferences regarding resuscitation efforts in the event of a medical emergency. However, it is often accompanied by other important forms that help clarify an individual's healthcare wishes. Below is a list of four additional documents frequently used alongside the DNR Order.
- Advance Healthcare Directive: This document allows individuals to outline their medical treatment preferences in situations where they may be unable to communicate their wishes. It often includes appointing a healthcare proxy to make decisions on their behalf.
- Living Will: A living will specifically addresses the types of medical treatment an individual wishes to receive or refuse in the event of a terminal illness or irreversible condition. It provides guidance to healthcare providers and family members during critical moments.
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- Healthcare Power of Attorney: This legal document designates a trusted person to make healthcare decisions for someone if they become incapacitated. The appointed agent can ensure that the individual's wishes, including those expressed in a DNR, are respected.
- Physician Orders for Life-Sustaining Treatment (POLST): This form translates a patient's preferences regarding life-sustaining treatments into actionable medical orders. It is particularly useful for individuals with serious illnesses, ensuring that their treatment preferences are honored by emergency responders and healthcare providers.
These documents collectively empower individuals to take control of their healthcare decisions. By utilizing them alongside the Delaware Do Not Resuscitate Order, individuals can ensure that their preferences are clearly communicated and respected in critical situations.
Key takeaways
Filling out a Do Not Resuscitate (DNR) Order form in Delaware is an important step in ensuring that your medical preferences are respected. Here are some key takeaways to keep in mind:
- Understand the Purpose: A DNR order indicates that you do not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
- Eligibility: Any adult can complete a DNR order, but it is particularly important for individuals with serious health conditions.
- Consult Your Healthcare Provider: Discuss your wishes with your doctor to ensure that a DNR order aligns with your overall care plan.
- Complete the Form Accurately: Fill out the DNR form carefully, providing all required information to avoid any confusion during emergencies.
- Signature Requirements: The form must be signed by you and your healthcare provider to be valid.
- Keep Copies Accessible: Make sure that copies of your DNR order are easily accessible to family members and healthcare providers.
- Review and Update: Revisit your DNR order regularly, especially if your health status or preferences change.
- Inform Family Members: Discuss your DNR wishes with your loved ones to ensure they understand your decisions.
- Know the Legal Protections: Familiarize yourself with the legal protections that exist for DNR orders in Delaware to ensure your wishes are honored.
By understanding these key points, you can make informed decisions about your medical care and ensure that your wishes are respected in critical situations.
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Form Properties
| Fact Name | Description |
|---|---|
| Purpose | The Delaware Do Not Resuscitate Order (DNR) form allows individuals to express their wishes regarding resuscitation efforts in the event of cardiac or respiratory arrest. |
| Governing Law | This form is governed by the Delaware Code, Title 16, Chapter 2501, which outlines the legal framework for advance healthcare directives. |
| Eligibility | Any adult, or a parent or guardian of a minor, can complete a DNR order in Delaware, ensuring that their healthcare preferences are respected. |
| Signature Requirement | The DNR form must be signed by the individual or their authorized representative, and it requires the signature of a physician to be valid. |
| Accessibility | The Delaware DNR form is readily available online and can be printed for completion, making it easy for individuals to prepare their advance directives. |