Fillable Do Not Resuscitate Order Document for the State of Delaware

Fillable Do Not Resuscitate Order Document for the State of Delaware

A Delaware Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form serves as a crucial tool for patients and healthcare providers, ensuring that personal preferences are respected during critical situations. Understanding the significance of this document can empower individuals to make informed decisions about their healthcare.

To take the next step in expressing your wishes, consider filling out the DNR form by clicking the button below.

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In the realm of healthcare decisions, the Delaware Do Not Resuscitate (DNR) Order form plays a crucial role in ensuring that individuals' wishes regarding end-of-life care are respected. This legally binding document allows patients to express their desire not to receive cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest or respiratory failure. It is essential for patients, families, and healthcare providers to understand the significance of this form, as it directly impacts the type of medical interventions that will be administered. The DNR form must be filled out accurately and signed by the patient or their legal representative, along with a physician’s signature to validate its authenticity. Furthermore, it is important to note that the form should be readily available in emergency situations, ensuring that first responders and medical staff can act in accordance with the patient’s preferences. By taking the time to complete a DNR Order, individuals can gain peace of mind, knowing that their healthcare choices will be honored, even when they are unable to communicate them. Understanding the implications and requirements of the DNR form is vital for anyone considering this important decision.

Dos and Don'ts

When filling out the Delaware Do Not Resuscitate Order form, it is important to approach the process with care. Here are some key points to consider:

  • Do consult with your healthcare provider before completing the form to ensure you understand the implications.
  • Do clearly indicate your wishes regarding resuscitation. Use straightforward language.
  • Do ensure that the form is signed and dated by both you and your healthcare provider.
  • Do keep a copy of the completed form in a safe place and share it with family members.
  • Don't use vague language or terms that could be misinterpreted.
  • Don't forget to update the form if your wishes change or if your health status changes.
  • Don't neglect to discuss your decision with loved ones; their support can be crucial.
  • Don't assume that verbal instructions will be sufficient; always complete the official form.

Sample - Delaware Do Not Resuscitate Order Form

Delaware Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is created in compliance with Delaware state laws governing advance healthcare directives. It serves to communicate the wishes of the patient regarding resuscitative measures.

Patient Information

  • Full Name: _____________________________
  • Date of Birth: ________________________
  • Address: ______________________________
  • Phone Number: ________________________

Physician Information

  • Full Name of Attending Physician: ____________________________
  • Medical License Number: ________________________________
  • Contact Information: _________________________________

Order Declaration

I hereby declare that:

  1. I do not want to receive life-sustaining measures in the event of cardiac arrest or respiratory failure.
  2. This decision has been made after careful consideration of my medical condition and prognosis.
  3. I understand the implications of this order and confirm that it reflects my wishes.

Signature Confirmation

This DNR order must be signed by the patient (or their legal representative) and the attending physician.

  • Patient Signature: ____________________________
  • Date: ____________________________
  • Physician Signature: ____________________________
  • Date: ____________________________

This document is intended to guide medical professionals regarding my wishes for resuscitation. It must be readily accessible to ensure that it can be acted upon when necessary.

Similar forms

The Delaware Do Not Resuscitate Order (DNR) form is similar to a living will. A living will outlines a person's preferences regarding medical treatment in situations where they cannot communicate their wishes. Both documents serve to guide healthcare providers and family members in making decisions that align with an individual's desires. While a DNR specifically addresses the refusal of resuscitation efforts, a living will may cover a broader range of medical interventions, including life support and palliative care options.

Another document akin to the DNR is a medical power of attorney. This legal form designates a trusted individual to make healthcare decisions on behalf of a person if they become incapacitated. Like the DNR, it ensures that a person's medical preferences are respected. However, while a DNR focuses on specific life-saving measures, a medical power of attorney grants broader authority to the appointed agent, allowing them to make various medical decisions based on the individual's overall wishes.

The advance directive is also comparable to the DNR. An advance directive combines elements of a living will and a medical power of attorney. It provides instructions for medical treatment preferences and designates a healthcare proxy. This document ensures that both the individual's wishes regarding resuscitation and other medical interventions are clearly communicated. The DNR serves as a specific directive within the broader context of an advance directive.

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Lastly, the Physician Orders for Life-Sustaining Treatment (POLST) form shares similarities with the DNR. The POLST is a medical order that translates a patient’s preferences regarding life-sustaining treatments into actionable orders for healthcare providers. Like the DNR, it is designed for individuals with serious health conditions. The POLST goes further by addressing various treatment options beyond resuscitation, ensuring that all aspects of a patient’s care align with their wishes.

Common mistakes

  1. Failing to clearly indicate the patient's wishes. It's crucial that the intention to not receive resuscitation is unmistakable. Ambiguities can lead to unintended consequences.

  2. Not having the form signed by the appropriate parties. The form must be signed by the patient or their authorized representative, along with a physician's signature to ensure its validity.

  3. Using outdated forms. Always check that you are using the most current version of the Delaware Do Not Resuscitate Order form. Regulations can change, and using an old form can invalidate the order.

  4. Neglecting to provide copies to relevant parties. After completing the form, it is essential to share copies with healthcare providers, family members, and anyone involved in the patient's care.

  5. Overlooking the importance of discussing the decision with loved ones. Engaging in open conversations can prevent confusion and ensure that everyone understands the patient's wishes.

  6. Failing to review and update the order regularly. Life circumstances change, and so might the patient's preferences. Regular reviews can help keep the order aligned with current wishes.

  7. Not understanding the implications of the order. It is vital to fully comprehend what a Do Not Resuscitate Order entails, including the potential impact on the patient's care.

  8. Assuming that the form is only necessary in a hospital setting. The order should be accessible in all care environments, including at home or in assisted living facilities.

Documents used along the form

The Delaware Do Not Resuscitate Order form is an important document for individuals wishing to outline their preferences regarding medical interventions in emergencies. Several other forms and documents are often used in conjunction with this order to ensure that a person's healthcare wishes are clearly communicated and respected. Below is a list of these related documents.

  • Advance Health Care Directive: This document allows individuals to specify their healthcare preferences and appoint a healthcare agent to make decisions on their behalf if they become unable to do so.
  • Living Will: A living will outlines a person's wishes regarding medical treatment in situations where they are terminally ill or permanently unconscious, providing guidance to healthcare providers and family members.
  • Durable Power of Attorney for Health Care: This legal document designates an individual to make healthcare decisions for someone else, ensuring that their wishes are honored even if they cannot communicate them.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that details a patient's preferences for life-sustaining treatments, ensuring that these preferences are honored across various healthcare settings.
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  • Hospital Do Not Resuscitate Order: This specific order is used within hospital settings to indicate a patient's wishes regarding resuscitation efforts during their stay, complementing the Delaware Do Not Resuscitate Order.
  • Emergency Medical Services (EMS) DNR Form: This form is used by emergency responders to identify patients who have a valid Do Not Resuscitate order, ensuring that their wishes are respected in emergency situations.
  • Organ Donation Registration: This document allows individuals to express their wishes regarding organ donation, providing clarity on their intentions after death.
  • Patient Advocate Designation: This form designates a person to advocate for a patient’s wishes and needs in healthcare settings, ensuring their voice is heard even when they cannot speak for themselves.
  • Medical Records Release Authorization: This document allows individuals to authorize the release of their medical records to specific individuals or organizations, ensuring that those involved in their care have access to necessary information.

These documents work together to create a comprehensive plan for healthcare preferences, ensuring that individuals' wishes are clearly communicated and respected in various medical situations. It is essential to review and update these documents regularly to reflect any changes in personal circumstances or healthcare preferences.

How to Use Delaware Do Not Resuscitate Order

Filling out the Delaware Do Not Resuscitate Order form is an important step in ensuring that your healthcare preferences are respected. This document allows you to communicate your wishes regarding resuscitation in a clear and legal manner. Once completed, it should be shared with your healthcare provider and kept in a location where it can be easily accessed in case of an emergency.

  1. Obtain the Delaware Do Not Resuscitate Order form. You can find this form online or request it from your healthcare provider.
  2. Begin by filling in your personal information. This typically includes your full name, date of birth, and contact information.
  3. Next, indicate your wishes regarding resuscitation. Carefully read the options provided and select the one that aligns with your preferences.
  4. Sign and date the form. Your signature confirms that you understand the implications of your choices.
  5. Have a witness sign the form. This witness should be an adult who is not related to you and is not involved in your healthcare. Their signature helps validate your wishes.
  6. Make copies of the completed form. Distributing these copies to your healthcare provider, family members, and anyone else involved in your care ensures that your preferences are known.
  7. Store the original form in a safe but accessible location. Consider placing it in your medical records or with your advance directives.

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