Attorney-Approved Washington Do Not Resuscitate Order Template
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The Washington 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 cardiac or respiratory arrest. This form allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures. It is important to note that the DNR Order is not a declaration of intent to forgo all medical treatment; rather, it specifically addresses resuscitation efforts. The form must be signed by the patient or their authorized representative and requires the signature of a physician to be valid. Additionally, it is recommended that individuals discuss their wishes with family members and healthcare providers to ensure that their decisions are understood and respected. The DNR Order can be easily identified by its distinctive color, which helps medical personnel recognize it quickly in emergency situations. Understanding the implications of this document is vital for both patients and their families, as it provides a means to maintain control over end-of-life care preferences while ensuring that healthcare providers are aware of these wishes during critical moments.
Key takeaways
Filling out and using the Washington Do Not Resuscitate Order (DNR) form requires careful consideration. Below are key takeaways to keep in mind:
- The DNR form is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
- It is important for individuals to discuss their wishes with family members and healthcare providers before completing the form.
- The form must be signed by the patient or their legal representative to be valid.
- Healthcare providers are required to honor a valid DNR order in any medical setting.
- The DNR form should be easily accessible, ideally kept in a location where medical personnel can readily find it.
- Patients can revoke the DNR order at any time by destroying the document or verbally communicating their decision to healthcare providers.
- It is advisable to review and update the DNR order periodically, especially after significant changes in health status.
- In Washington, the DNR form can be obtained from healthcare providers or downloaded from official state resources.
Dos and Don'ts
When filling out the Washington Do Not Resuscitate (DNR) Order form, it is essential to approach the process with care and consideration. This document is significant, as it communicates your wishes regarding medical interventions in emergency situations. Below are some important dos and don’ts to keep in mind.
- Do ensure that you fully understand what a DNR order entails before completing the form.
- Do consult with your healthcare provider to discuss your wishes and any potential implications.
- Do clearly indicate your preferences on the form, making sure to sign and date it as required.
- Do keep copies of the completed DNR order in accessible locations, such as with your medical records and with family members.
- Don’t leave any sections of the form blank, as this could lead to confusion or misinterpretation of your wishes.
- Don’t assume that verbal communication of your wishes is sufficient; a signed document is necessary for it to be legally recognized.
Documents used along the form
In addition to the Washington Do Not Resuscitate Order form, several other documents are commonly used to ensure that an individual's healthcare preferences are honored. These documents provide essential information regarding medical treatment, decision-making authority, and end-of-life care. Below is a list of related forms that may be relevant.
- Advance Directive: This document outlines a person's preferences for medical treatment in situations where they cannot communicate their wishes. It may include instructions regarding life-sustaining treatments and appoints a healthcare agent.
- Durable Power of Attorney for Healthcare: This form designates an individual to make healthcare decisions on behalf of another person if they become incapacitated. It is crucial for ensuring that one's healthcare preferences are respected.
- Living Will: A living will specifies what types of medical treatment a person wishes to receive or refuse in the event of a terminal illness or irreversible condition. It serves as a guide for healthcare providers and family members.
- Physician Orders for Life-Sustaining Treatment (POLST): This document translates a patient's wishes regarding life-sustaining treatment into actionable medical orders. It is particularly useful for those with serious illnesses.
- Healthcare Proxy: A healthcare proxy form allows an individual to appoint someone to make medical decisions on their behalf. This person acts according to the individual's wishes and best interests.
- Do Not Intubate (DNI) Order: This order specifies that a patient should not be intubated in the event of respiratory failure. It is often used alongside a DNR order to clarify treatment preferences.
- General Power of Attorney: For those looking to manage their financial and health decisions, our comprehensive General Power of Attorney form helps designate an agent to act on your behalf.
- Organ Donation Consent Form: This document expresses an individual's wishes regarding organ donation after death. It is important for ensuring that one's wishes are honored and can facilitate the donation process.
- Patient Advocate Designation: This form allows a person to appoint a patient advocate who can assist in navigating healthcare decisions and ensure that the individual's preferences are communicated effectively.
These documents collectively help individuals articulate their healthcare preferences and ensure that their wishes are respected in critical situations. It is advisable to review and complete these forms to provide clarity and guidance for healthcare providers and loved ones.
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Things to Know About This Form
What is a Do Not Resuscitate (DNR) Order in Washington State?
A Do Not Resuscitate Order is a legal document that allows individuals to refuse certain life-saving medical interventions in the event of a cardiac arrest or respiratory failure. In Washington State, this order specifically instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) or other resuscitative measures. It is designed for patients who wish to avoid aggressive medical interventions when they are near the end of life.
Who can request a DNR Order?
Any adult who is capable of making their own medical decisions can request a DNR Order. This includes individuals who are facing terminal illnesses, severe chronic conditions, or other situations where resuscitation would not align with their personal wishes. Additionally, a parent or legal guardian can request a DNR for a minor. It is important that the individual fully understands the implications of the order before making this decision.
How do I obtain a DNR Order in Washington State?
To obtain a DNR Order, follow these steps:
- Consult with your healthcare provider. Discuss your medical condition and your wishes regarding resuscitation.
- If appropriate, your doctor will complete the DNR Order form. This form must be signed by both you and your physician.
- Keep a copy of the signed DNR Order in a safe but accessible place. You may also want to provide copies to your family, caregivers, and healthcare facilities.
Is a DNR Order valid in all healthcare settings?
Yes, a DNR Order that is properly completed and signed is valid in all healthcare settings in Washington State. This includes hospitals, nursing homes, and emergency medical services. However, it is essential to ensure that the order is readily available to healthcare providers at the time of an emergency.
Can I change or revoke my DNR Order?
Absolutely. You have the right to change or revoke your DNR Order at any time. If you decide to do so, simply inform your healthcare provider and ensure that any new documents are properly signed. It is also a good idea to inform your family and caregivers about your decision to ensure that your current wishes are respected.
Preview - Washington Do Not Resuscitate Order Form
Washington Do Not Resuscitate Order Template
This Do Not Resuscitate (DNR) order is made in accordance with Washington state law, specifically Chapter 70.122 RCW. It expresses the wishes of the individual regarding resuscitation efforts in the event of cardiac or respiratory arrest.
Patient Information:
- Full Name: __________________________
- Date of Birth: ______________________
- Address: ____________________________
- City: _______________________________
- State: ______________________________
- Zip Code: __________________________
Healthcare Decision Maker (if applicable):
- Full Name: __________________________
- Relationship to Patient: ______________
- Phone Number: ______________________
- Address: ____________________________
This DNR order is valid until revoked. The patient's preference regarding resuscitation is as follows:
- Do Not Resuscitate: The patient does not wish to undergo resuscitative measures in the event of a cardiac or respiratory arrest.
Patient Signature: ______________________ Date: ____________________
Witness Signature: _____________________ Date: ____________________
It is advisable to keep copies of this order in easily accessible locations such as with the patient's medical records or with their appointed healthcare proxy. Always inform healthcare providers of this order. Thank you for ensuring that the patient's wishes are respected during critical moments.
Document Attributes
| Fact Name | Description |
|---|---|
| Definition | A Do Not Resuscitate (DNR) order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops beating or they stop breathing. |
| Governing Law | The Washington DNR order is governed by the Revised Code of Washington (RCW) 70.122. |
| Eligibility | Any adult can complete a DNR order, provided they are capable of making their own healthcare decisions. |
| Form Requirements | The DNR order must be signed by the patient or their legal representative and a physician. |
| Validity | A DNR order is valid in all healthcare settings, including hospitals, nursing homes, and at home. |
| Revocation | Patients can revoke a DNR order at any time. This can be done verbally or by destroying the document. |
| Notification | It is important to inform healthcare providers and family members about the existence of a DNR order. |
| Emergency Medical Services | Emergency Medical Services (EMS) personnel must honor a DNR order if it is properly executed and presented. |
| Additional Documents | A DNR order can be part of a broader advance directive, which includes other healthcare preferences. |
How to Fill Out Washington Do Not Resuscitate Order
Filling out a Do Not Resuscitate (DNR) Order form in Washington can be an important step in ensuring that your medical preferences are respected. This process involves several steps to ensure that the form is completed accurately and clearly. Here’s how to proceed.
- Obtain the Washington DNR Order form. You can find it online or request it from your healthcare provider.
- Carefully read the instructions provided with the form. Understanding the requirements will help you fill it out correctly.
- Fill in your personal information, including your full name, date of birth, and address. This information identifies you clearly.
- Next, indicate your wishes regarding resuscitation by checking the appropriate box on the form. Make sure your choice reflects your true preferences.
- Sign and date the form. Your signature is crucial as it confirms that you understand and agree to the contents of the DNR Order.
- Have a witness sign the form. This person should not be a family member or anyone who would benefit from your medical decisions.
- Provide copies of the completed form to your healthcare provider and keep a copy for yourself. It’s important that your wishes are known and accessible.
Once the form is filled out and distributed, it is advisable to discuss your decision with family members and healthcare providers. This ensures that everyone understands your wishes and can act accordingly in the event of a medical emergency.