Homepage Fillable Do Not Resuscitate Order Document for Pennsylvania State

Common mistakes

Completing a Do Not Resuscitate (DNR) Order form in Pennsylvania is a significant step in ensuring that your healthcare preferences are respected. However, many individuals make mistakes during this process that can lead to confusion or unintended consequences. One common error is failing to provide clear and specific instructions. It is crucial that the form reflects your wishes accurately. Ambiguities can lead to misunderstandings among medical personnel, potentially resulting in unwanted resuscitation efforts.

Another frequent mistake involves not having the form properly signed and witnessed. In Pennsylvania, a DNR Order must be signed by the patient or their authorized representative, and it must also be witnessed by two individuals who are not related to the patient or involved in their medical care. Without these signatures, the document may not be considered valid, leaving your wishes unfulfilled in critical moments.

Additionally, some individuals neglect to discuss their DNR preferences with family members or healthcare providers before filling out the form. Open communication is vital. When loved ones are unaware of your decisions, it can create tension or conflict during a medical crisis. Ensuring that everyone is informed can help prevent emotional distress and facilitate adherence to your wishes.

Moreover, failing to keep the DNR Order accessible is another mistake. After completing the form, it should be placed in a location where it can be easily found by medical staff, such as on the refrigerator or in a medical alert system. If the form is not readily available, healthcare providers may not be aware of your preferences, leading to unwanted interventions.

Lastly, individuals often overlook the need to review and update their DNR Orders periodically. Life circumstances change, and so do personal preferences regarding medical treatment. Regularly revisiting the DNR form ensures that it continues to reflect your current wishes and that any changes in your health status or personal beliefs are accurately documented.

Dos and Don'ts

When filling out the Pennsylvania Do Not Resuscitate Order form, it's important to follow certain guidelines to ensure your wishes are clearly understood. Here’s a list of what you should and shouldn’t do:

  • Do ensure that you understand the implications of a Do Not Resuscitate Order.
  • Do consult with your healthcare provider before completing the form.
  • Do sign and date the form in the presence of a witness.
  • Do keep a copy of the completed form for your records.
  • Don't fill out the form under pressure or without full understanding.
  • Don't forget to communicate your wishes to family members and caregivers.
  • Don't assume that your verbal wishes are enough; always have a written order.

Similar forms

The Pennsylvania Do Not Resuscitate (DNR) Order form is similar to the Advance Directive. An Advance Directive allows individuals to outline their healthcare preferences in case they become unable to communicate their wishes. Like the DNR, it serves to ensure that medical personnel respect a person's choices regarding life-sustaining treatments. Both documents aim to provide clarity about what kind of medical care a person desires, especially in critical situations.

Another document akin to the DNR is the Living Will. A Living Will specifically details the types of medical treatments an individual does or does not want in situations where they cannot express their wishes. This document complements the DNR by providing additional context about a person's healthcare preferences, ensuring that their choices regarding end-of-life care are honored.

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The Healthcare Power of Attorney (POA) shares similarities with the DNR Order as well. This document designates a trusted person to make medical decisions on behalf of someone who is incapacitated. While the DNR focuses solely on resuscitation efforts, the POA can cover a broader range of healthcare decisions. Both documents empower individuals to have control over their medical care, even when they cannot communicate directly.

The Physician Orders for Life-Sustaining Treatment (POLST) form is another document that aligns with the DNR. The POLST is a medical order that translates a patient's preferences into actionable medical orders. It is designed for those with serious illnesses or advanced age. Like the DNR, the POLST ensures that medical staff follow the patient's wishes regarding life-sustaining treatments, providing a clear directive for emergency situations.

The Medical Order for Life-Sustaining Treatment (MOLST) is similar to the POLST and the DNR. This document is also intended for individuals with serious health conditions. The MOLST outlines specific medical treatments that should be provided or withheld. It serves to communicate a patient's preferences clearly and ensures that healthcare providers understand their wishes regarding resuscitation and other life-sustaining measures.

Lastly, the Do Not Intubate (DNI) order is closely related to the DNR. A DNI specifically instructs healthcare providers not to place a patient on a ventilator if they stop breathing. While the DNR addresses all forms of resuscitation, the DNI focuses solely on breathing assistance. Both documents are vital for ensuring that a patient’s wishes regarding critical care are respected in emergencies.

Guidelines on How to Fill Out Pennsylvania Do Not Resuscitate Order

Filling out the Pennsylvania Do Not Resuscitate Order form is a crucial step in ensuring your healthcare preferences are honored. After completing the form, it is important to keep a copy for your records and share it with your healthcare providers and loved ones.

  1. Obtain the Pennsylvania Do Not Resuscitate Order form. This can typically be found online or through healthcare providers.
  2. Begin by entering your personal information at the top of the form. This includes your full name, address, and date of birth.
  3. Identify the person who will be your healthcare representative, if applicable. Include their name and contact information.
  4. Clearly indicate your wishes regarding resuscitation by checking the appropriate box on the form.
  5. Sign and date the form at the designated area. This confirms that you understand and agree to the contents of the document.
  6. Have your signature witnessed by two adults who are not related to you and do not stand to gain from your estate. They should also sign and date the form.
  7. Make copies of the completed form for your records and share them with your healthcare provider and family members.

Form Preview Example

Pennsylvania Do Not Resuscitate Order

This Do Not Resuscitate Order (DNR) is created in accordance with Pennsylvania state laws to communicate the patient’s wishes regarding emergency medical treatment. This document should be filled out carefully to ensure it accurately reflects the individual’s preferences.

Patient Information:

  • Patient's Full Name: _______________
  • Date of Birth: _______________
  • Address: _______________
  • Phone Number: _______________

Emergency Contact Information:

  • Contact Name: _______________
  • Relationship to Patient: _______________
  • Phone Number: _______________

The patient hereby declares that in the event of a medical emergency, when the heart stops or breathing ceases, they do not wish to receive CPR (cardiopulmonary resuscitation) or other resuscitative measures.

Patient’s Signature: _______________

Date: _______________

Witness Information:

  • Witness Name: _______________
  • Witness Signature: _______________
  • Date: _______________

This order must be signed and dated by the patient or their authorized representative, along with a witness. Ensure that copies of this document are distributed to the patient’s healthcare providers and emergency contacts to facilitate compliance with the patient’s wishes.

For further questions or clarifications regarding this DNR order, consult healthcare providers or legal professionals knowledgeable in this area.

Document Specifics

Fact Name Description
Legal Basis The Pennsylvania Do Not Resuscitate Order (DNR) form is governed by the Pennsylvania Consolidated Statutes, Title 20, Chapter 54.
Purpose This form allows individuals to refuse resuscitation efforts in the event of a medical emergency, ensuring their end-of-life wishes are respected.
Eligibility Any adult who is capable of making their own healthcare decisions can complete a DNR order.
Signature Requirement The form must be signed by the patient, or their authorized representative, and a physician to be considered valid.
Revocation Individuals can revoke a DNR order at any time. This can be done verbally or by destroying the form.