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Free Do Not Resuscitate Order Template for Pennsylvania

A Pennsylvania Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to refuse resuscitation efforts in the event of a medical emergency. This form is crucial for ensuring that a person's healthcare wishes are respected when they are unable to communicate. Understanding how to properly complete and use this form can provide peace of mind for both patients and their families.

Form Sample

Pennsylvania Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is created in accordance with the laws of the Commonwealth of Pennsylvania. This document expresses the wishes of the individual named below regarding resuscitation efforts in the event of a medical emergency.

Patient Information:

Full Name: ______________________________________
Date of Birth: ____________________________________
Address: _________________________________________
City: ____________________________________________
State: ____________ Zip Code: ______________________

Physician Information:

Full Name: ______________________________________
Office Address: __________________________________
City: ____________________________________________
State: ____________ Zip Code: ______________________
Phone Number: __________________________________

Declaration

I, the undersigned, understand that this Do Not Resuscitate Order indicates that I do not wish to receive cardiopulmonary resuscitation (CPR) if my heart stops beating or if I stop breathing. This decision has been made voluntarily and in consideration of my medical condition and prognosis.

Signature:

____________________________________________________________________

Date: ____________

Witness Information:

Full Name: ______________________________________
Signature: ______________________________________
Date: __________________________________________

Please ensure this document is stored in a safe location and a copy is provided to your healthcare provider and family members. It is crucial that your wishes are known and honored in any medical situation.

Misconceptions

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

A DNR means that no medical care will be provided. This is not true. A DNR specifically indicates that a person does not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. Other medical treatments and care will still be provided as needed.
Only terminally ill patients need a DNR. While many people associate DNR orders with terminal illness, anyone can choose to have a DNR, regardless of their health status. It is a personal decision based on individual values and preferences.
A DNR is the same as a living will. These are different documents. A living will outlines a person's wishes regarding medical treatment in situations where they cannot communicate, while a DNR specifically addresses resuscitation efforts during cardiac arrest.
A DNR is permanent and cannot be changed. This is a misconception. A DNR order can be revoked or modified at any time by the individual who signed it, as long as they are capable of making decisions.
Healthcare providers will not respect my DNR wishes. In Pennsylvania, DNR orders are legally recognized and must be honored by healthcare providers. It is essential to ensure that the DNR form is properly completed and accessible to medical personnel.

Being well-informed about these misconceptions can help individuals navigate their healthcare decisions more confidently. It is always advisable to discuss any questions or concerns with a healthcare provider or legal professional.

Key takeaways

Filling out and utilizing the Pennsylvania Do Not Resuscitate (DNR) Order form is a significant step for individuals who wish to communicate their healthcare preferences. Below are key takeaways to consider:

Understanding the Purpose: The DNR Order form is designed to ensure that a person's wishes regarding resuscitation efforts are clearly documented and respected in medical situations.
Eligibility: Any adult who is capable of making informed decisions can complete a DNR Order. This includes individuals with terminal illnesses or those who wish to avoid aggressive medical interventions.
Completion Process: The form must be filled out accurately, including the patient’s name, date of birth, and signature. Additionally, it requires the signatures of two witnesses or a notary public to validate the document.
Distribution: Once completed, copies of the DNR Order should be distributed to healthcare providers, family members, and kept in a location that is easily accessible in case of an emergency.
Revocation: The DNR Order can be revoked at any time by the individual. It is important to communicate any changes to healthcare providers and ensure that new copies of the order are distributed.
State Regulations: Familiarize yourself with Pennsylvania's specific regulations regarding DNR Orders, as they may differ from other states. Understanding these regulations can help ensure that the order is valid and enforceable.

By keeping these points in mind, individuals can make informed decisions regarding their medical care and ensure their wishes are honored in critical situations.

More Do Not Resuscitate Order State Forms

Polst Form Wa - In certain emergency situations, verbal confirmation may be allowed until a formal DNR is presented.

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Can You Have a Dnr at Any Age - The DNR indicates that aggressive medical interventions are not desired by the patient.

What Does Dnr Mean - A DNR can be part of a broader advance directive or living will outlining your healthcare choices.