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Printable Do Not Resuscitate Order Document 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 ensures that a person's wishes regarding end-of-life care are respected by healthcare providers. Understanding the implications and processes surrounding the DNR form is essential for individuals and families making these important decisions.

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Printable Do Not Resuscitate Order Document for Pennsylvania

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The Pennsylvania Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals who wish to express their preferences regarding medical interventions in the event of a life-threatening situation. It is designed to communicate a person's desire to forgo cardiopulmonary resuscitation (CPR) and other life-saving measures in specific circumstances. This form is particularly important for patients with terminal illnesses or those facing severe, irreversible conditions. Completing a DNR Order involves careful consideration and discussion with healthcare providers, ensuring that the individual's wishes are clearly understood and respected. The document must be signed by both the patient and a physician to be legally binding. Additionally, it is essential to keep the DNR Order accessible, as emergency medical personnel must be able to review it promptly in critical situations. Understanding the implications and requirements of the DNR Order can provide peace of mind, allowing individuals to make informed choices about their end-of-life care. The process emphasizes the importance of communication between patients, families, and healthcare providers, ensuring that everyone is aligned with the patient’s wishes.

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Common Questions

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

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. Specifically, it indicates that a person does not want CPR (cardiopulmonary resuscitation) or other life-saving measures to be performed if their heart stops beating or they stop breathing. This form is particularly important for those with terminal illnesses or serious health conditions, as it ensures that their preferences are respected during critical moments.

Who can complete a DNR form in Pennsylvania?

In Pennsylvania, any adult who is capable of making their own medical decisions can complete a DNR form. This includes individuals who are 18 years or older and are of sound mind. Additionally, a DNR order can be completed by a legal guardian or an authorized representative if the individual is unable to do so themselves. It is crucial that the person completing the form understands the implications of the decision and has had discussions with their healthcare provider about their health status and treatment options.

How do I obtain a DNR form in Pennsylvania?

Obtaining a DNR form in Pennsylvania is a straightforward process. The form can typically be acquired from healthcare providers, hospitals, or online through the Pennsylvania Department of Health's website. It is essential to ensure that the form is the official state version to avoid any legal complications. Once the form is filled out, it must be signed by both the individual and their physician to be considered valid. After completion, copies should be kept in easily accessible locations, such as with the individual’s medical records and with family members.

What should I do if my wishes change after completing a DNR form?

If an individual’s wishes regarding resuscitation change after completing a DNR form, it is important to take action promptly. The existing DNR order can be revoked at any time by the individual. To do this, the person should destroy the original DNR form and notify their healthcare provider and family members of the change in wishes. It may also be advisable to complete a new DNR form that reflects the updated preferences. Clear communication with medical professionals and loved ones is key to ensuring that the individual’s current wishes are understood and respected.

Preview - Pennsylvania Do Not Resuscitate Order Form

Pennsylvania Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is executed in accordance with the laws of Pennsylvania. It reflects the wishes of the patient regarding resuscitation efforts in the event of a medical emergency.

Patient Information:

Name: _______________________________
Date of Birth: ______________________
Address: ____________________________
Medical Record Number: ______________

Physician Information:

Physician's Name: ____________________
Physician's Contact Number: ____________
Facility Name (if applicable): ____________

Order Details:

I, the undersigned patient, declare that I do not wish to receive resuscitation in the event of cardiac or respiratory arrest. This decision has been made voluntarily and reflects my healthcare preferences.

Signature: ____________________________________

Date: ________________________________________

Witness Information:

Witness Name (Printed): _____________________
Witness Signature: ___________________________
Date: ______________________________________

Please keep this order visible in the patient's medical records and notify all healthcare providers of this DNR status.

Similar forms

Living Will: A living will outlines a person's wishes regarding medical treatment in situations where they are unable to communicate. Like a Do Not Resuscitate Order (DNR), it provides guidance to healthcare providers about the individual's preferences for end-of-life care.
Durable Power of Attorney for Healthcare: This document designates someone to make healthcare decisions on behalf of an individual if they are incapacitated. Similar to a DNR, it ensures that a person's medical preferences are respected, even when they cannot voice them.
POLST (Physician Orders for Life-Sustaining Treatment): A POLST form translates a patient's treatment preferences into actionable medical orders. It is similar to a DNR in that it provides clear instructions to medical personnel about the desired level of care.
Advanced Healthcare Directive: This document combines a living will and a durable power of attorney. It allows individuals to express their healthcare preferences and appoint a decision-maker, paralleling the intent of a DNR.
Do Not Intubate (DNI) Order: A DNI order specifically addresses the decision to avoid intubation in respiratory failure. Like a DNR, it reflects a patient's wishes regarding life-sustaining measures.
Comfort Care Order: This document focuses on providing comfort rather than aggressive treatment. It shares similarities with a DNR as both prioritize quality of life over prolonging life through medical interventions.
Mobile Home Bill of Sale: For those involved in mobile home transactions, understanding the importance of a bill of sale is essential, and you can find a template at mobilehomebillofsale.com/blank-florida-mobile-home-bill-of-sale/.
Healthcare Proxy: A healthcare proxy is a legal document that designates an individual to make medical decisions on someone’s behalf. It serves a similar purpose to a DNR by ensuring that a person's wishes are followed in critical situations.
Emergency Medical Services (EMS) DNR Form: This form is specifically for use by emergency medical personnel. It functions like a standard DNR, indicating that resuscitation efforts should not be initiated in case of cardiac arrest.

Misconceptions

Understanding the Pennsylvania Do Not Resuscitate (DNR) Order form is essential for patients and their families. However, several misconceptions can lead to confusion and anxiety. Below are five common misconceptions about the Pennsylvania DNR Order form, along with clarifications.

A DNR means that no medical care will be provided. This is not true. A DNR specifically addresses resuscitation efforts in the event of cardiac arrest. Patients can still receive all other forms of medical care and treatment.
Only terminally ill patients can have a DNR. This misconception is misleading. While many individuals with terminal conditions choose to have a DNR, anyone can request one. 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 various situations, while a DNR specifically focuses on resuscitation efforts.
Once a DNR is signed, it cannot be changed or revoked. This is incorrect. Individuals can change or revoke their DNR orders at any time, as long as they are capable of making that decision.
A DNR is only valid in a hospital setting. This is a common misunderstanding. In Pennsylvania, a DNR order is valid in various settings, including at home and in nursing facilities, as long as it is properly completed and recognized by medical personnel.

Addressing these misconceptions can help individuals make informed decisions about their healthcare preferences. Open discussions with healthcare providers can further clarify any uncertainties surrounding DNR orders.

Form Overview

Fact Name	Details
Definition	A Do Not Resuscitate (DNR) Order in Pennsylvania is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Governing Law	The Pennsylvania Do Not Resuscitate Order is governed by the Pennsylvania Consolidated Statutes, Title 20, Chapter 54.
Eligibility	Any adult who is capable of making their own healthcare decisions can complete a DNR Order in Pennsylvania.
Signature Requirement	The DNR Order must be signed by the patient or their authorized representative, along with a physician's signature.
Form Availability	The DNR Order form is available through healthcare providers, hospitals, and online resources provided by the state.
Revocation	A DNR Order can be revoked at any time by the patient or their representative, verbally or in writing.
Placement	It is recommended that the DNR Order be placed in a visible location, such as on the refrigerator or in the medical records, to ensure it is easily accessible during emergencies.
Emergency Medical Services	Emergency medical services (EMS) personnel are required to honor a valid DNR Order, provided it is properly completed and signed.