Attorney-Verified  Do Not Resuscitate Order Form for Colorado

Attorney-Verified Do Not Resuscitate Order Form for Colorado

A Colorado Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of cardiac arrest or respiratory failure. This form provides peace of mind for both patients and healthcare providers, ensuring that medical interventions align with the patient’s values and preferences. If you or a loved one are considering completing this form, do not hesitate to take the first step by clicking the button below.

Content Overview

The Colorado Do Not Resuscitate (DNR) Order form provides individuals with a crucial option for end-of-life care, allowing them to express their wishes regarding medical interventions in the event of a life-threatening situation. This form is generally used by patients who have a terminal illness or a serious medical condition and wish to avoid aggressive resuscitation efforts. It includes essential information such as the patient's name, date of birth, and specifics about the desired scope of treatment. Additionally, the form must be signed by a physician, ensuring that medical professionals are aware of the patient's preferences. Family members and loved ones can also benefit from understanding this form, as it clarifies what actions should or should not be taken during a medical emergency. By addressing these vital elements, the Colorado DNR Order serves as a powerful tool in honoring individual choices and fostering peace of mind during challenging times.

Colorado Do Not Resuscitate Order Sample

Colorado Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is created in accordance with Colorado state laws. Please fill out the information below to establish your wishes regarding resuscitation.

Patient Information:

  • Full Name: _______________________________
  • Date of Birth: ___________________________
  • Medical Record Number: ___________________
  • Address: ________________________________
  • Phone Number: ___________________________

Healthcare Provider Information:

  • Doctor’s Name: ___________________________
  • Practice Name: __________________________
  • Phone Number: ___________________________

I, (Patient's Name), recognize that I have the right to refuse resuscitative measures. In the event of a medical emergency, I specifically request that the medical team does not initiate resuscitation efforts, including but not limited to:

  • Cardiopulmonary resuscitation (CPR)
  • Advanced airway management
  • Defibrillation
  • Medications specifically for resuscitation

This order is applicable in all settings, including but not limited to hospitals, emergency rooms, and at home.

Signatures:

  • Patient Signature: ___________________________
  • Date: ___________________________
  • Witness Signature: ___________________________
  • Date: ___________________________
  • Healthcare Provider Signature: ___________________________
  • Date: ___________________________

This document must be kept with your medical records and a copy should be provided to your healthcare provider. For further clarification on the legal aspects of this order, please refer to § 15-18-103 of the Colorado Revised Statutes.

PDF Specifications

Fact Name Description
Form Purpose The Colorado Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation attempts in the event of a medical emergency.
Legal Authority The DNR Order is governed by Colorado Revised Statutes, specifically § 25-48-101 through § 25-48-106.
Eligibility Any adult patient or legally authorized representative can complete and sign the DNR form.
Signature Requirement The form must be signed by the patient or their authorized representative to be valid.
Healthcare Provider Involvement A licensed physician must sign the DNR Order to ensure its authenticity and compliance with state laws.
Document Accessibility It is advisable to keep the DNR form easily accessible. Medical personnel should be able to locate it quickly during an emergency.
Revocation Process Patients have the right to revoke their DNR Order at any time. This can be done verbally or in writing.
Distribution Copies of the DNR Order should be distributed to healthcare providers, family members, and stored in medical records.

Colorado Do Not Resuscitate Order: Usage Instruction

When preparing to fill out the Colorado Do Not Resuscitate Order form, gather the necessary information and ensure you have a clear understanding of your healthcare preferences. This form requires careful attention to detail, as it reflects important decisions regarding your medical care.

  1. Obtain the Colorado Do Not Resuscitate Order form from a reliable source, such as a healthcare provider or the official state website.
  2. Start by completing the patient’s information. This includes the patient’s full name, date of birth, and address.
  3. Identify the healthcare representative. Provide their name and contact details to ensure they can be reached when necessary.
  4. Clearly state the wishes regarding resuscitation. Mark your preferences regarding CPR and other resuscitation methods.
  5. Have the form signed by the patient or their legally recognized representative. Make sure this is done in the presence of a witness.
  6. Ensure that the witness signs the form as well. The witness should confirm that the patient signed the form without any pressure.
  7. Make copies of the completed form for the patient, their representative, and relevant healthcare providers.

After completing the form, keep it in a safe place where it can be easily accessed. Share copies with your healthcare team to ensure your wishes are understood and respected. Regularly review the document, especially if your circumstances or preferences change.

Frequently Asked Questions

  1. What is a Do Not Resuscitate (DNR) Order?

    A Do Not Resuscitate Order is a medical directive that informs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event that a patient's heart stops or they stop breathing. This order is typically used to respect the wishes of individuals who prefer not to undergo resuscitation efforts in critical situations.

  2. How can I obtain a DNR Order in Colorado?

    In Colorado, you can obtain a DNR Order by discussing your preferences with your physician. Your doctor can provide the appropriate form and guide you through the process of completing it. It is essential that the form is signed by both you and your physician for it to be valid.

  3. Who can request a DNR Order?

    Any individual aged 18 or older may request a DNR Order. In cases where the individual is unable to make decisions for themselves, a legally authorized representative, such as a guardian or healthcare proxy, may request it on their behalf.

  4. Is a DNR Order valid outside of a hospital setting?

    Yes, a Colorado DNR Order is valid in various settings, including homes, nursing facilities, and hospitals. However, it is advisable to have the DNR Order readily available and communicated to all relevant parties, including caregivers and family members.

  5. Can I revoke a DNR Order once it is in place?

    Yes, you have the right to revoke a DNR Order at any time. This can be done verbally or in writing. It is important to notify your healthcare providers, family members, and anyone involved in your care of this decision.

  6. What information is needed to complete a DNR Order form?

    The DNR Order form will typically require your personal information, such as your name, date of birth, and medical history, along with your physician's details. Both you and your physician must sign the document to validate it.

  7. Are there legal considerations regarding DNR Orders?

    DNR Orders are legally recognized documents in Colorado, but they must comply with state laws. To ensure that your DNR Order is valid, it is advisable to consult legal or healthcare professionals who are knowledgeable about state regulations.

  8. What happens if a healthcare provider does not follow the DNR Order?

    If a healthcare provider ignores a valid DNR Order, they may be subject to legal liability. It is crucial that you discuss your DNR Order with your care team to ensure everyone is aware of your wishes.

  9. Can family members override a DNR Order?

    Generally, family members cannot override a DNR Order if it has been legally established and signed by the patient and their physician. However, discussing your wishes with family members can help prevent misunderstandings and ensure that everyone is on the same page.

  10. Are there any costs associated with obtaining a DNR Order?

    Obtaining a DNR Order itself typically does not incur any costs. However, you may want to confirm with your healthcare provider if there are any administrative fees associated with the process.

Common mistakes

When filling out the Colorado Do Not Resuscitate (DNR) Order form, many people make simple yet significant mistakes. One common error is not including the patient's full name. This may lead to confusion about whom the order applies to. Full identification details are essential to ensure that the DNR is properly recognized in medical situations.

Another frequent mistake is not signing the form. For the DNR to be valid, it must be signed by the patient or their authorized representative. Without a signature, medical providers may disregard the order, assuming it was never completed.

Many individuals also overlook the need for a witness to the signature. The Colorado form requires at least one witness to validate the order. Failing to have witnesses can result in the order being deemed invalid, which defeats the purpose of having it in place.

Inaccurate details about the patient's medical condition can create problems down the line. Some people fail to provide relevant health history or current medications, which might influence medical decisions. Always ensure that the information presented is up-to-date and accurate.

Another misunderstanding arises with the understanding of the scope of the DNR order. Some individuals mistakenly think that a DNR means "do not treat" in all situations. It is crucial to clarify that the DNR only applies to resuscitation efforts and does not affect other medical treatments that may be necessary.

Additionally, people often forget to communicate their wishes clearly with family members and healthcare providers. The order should not only be filled out but also discussed with loved ones. Open communication can prevent confusion and ensure that everyone is on the same page regarding care preferences.

Finally, many neglect to keep a copy of the DNR order accessible. If the form is not readily available in an emergency situation, healthcare professionals may not know the patient’s wishes. Keeping copies at home, with family members, and with healthcare providers can alleviate this issue.

Documents used along the form

Understanding various medical forms and documents can significantly aid individuals in making informed choices about their health care. The Colorado Do Not Resuscitate (DNR) Order is one important document, but many other forms complement it in ensuring that a person's medical wishes are honored. Below is a list of additional commonly used forms that often accompany the DNR Order.

  • Advance Directive: This document outlines a person's healthcare preferences in the event they become unable to communicate these wishes. It can specify treatments a person wishes to receive or avoid.
  • Medical Power of Attorney: This form designates an individual to make healthcare decisions on someone’s behalf if they cannot do so. This trusted person can ensure that care aligns with the patient’s values and preferences.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST forms guide emergency medical personnel in how to treat a patient based on their preferences documented on the form. Unlike a DNR, it can include orders for other interventions as well.
  • Living Will: This document specifies a person's wishes regarding medical treatment at the end of life, particularly when they are terminally ill or in a persistent vegetative state.
  • Healthcare Proxy: Similar to a medical power of attorney, this form allows an individual to appoint someone to make healthcare decisions that reflect their wishes when they are not able to do so.
  • Organ Donation Registration: This form indicates a person's wish to donate their organs and tissues after passing away, ensuring their intentions regarding organ donation are known and respected.
  • Do Not Intubate Order: This specific instruction can be used in conjunction with a DNR Order to clarify that a patient does not want to be put on a ventilator if they can’t breathe independently.
  • Health Care Decisions for Adults: This resource provides guidelines and explanations regarding how to make healthcare decisions, assisting individuals in resolving questions about their care options.
  • Patient Preferences Document: This informal document helps a person outline their preferences for medical treatments, procedures, and other aspects of care that may not be captured in formal documents.

Having these additional forms on hand allows individuals to create a comprehensive plan for their medical care. It ensures that their choices are understood and respected by medical staff and family members, offering peace of mind during uncertain times.

Similar forms

A Do Not Resuscitate (DNR) Order is important for individuals who wish to make their medical preferences known regarding resuscitation efforts in the event of cardiac arrest. Several other documents serve a similar purpose in empowering individuals to express their healthcare wishes. Here are five documents that share similarities with a DNR Order:

  • Living Will: A living will outlines a person's preferences for medical treatment in situations where they cannot communicate their wishes. Like a DNR, it addresses end-of-life decisions but can encompass a wider range of medical scenarios.
  • Durable Power of Attorney for Healthcare: This document designates a trusted individual to make healthcare decisions on behalf of someone who is incapacitated. Both a durable power of attorney and a DNR focus on honoring the patient's wishes regarding medical interventions.
  • MOLST (Medical Orders for Life-Sustaining Treatment): MOLST is a medical order that reflects a patient's preferences regarding life-sustaining treatments, including resuscitation. It serves as a more comprehensive medical guide than a DNR, detailing various treatment options beyond resuscitation.
  • Physician Orders for Life-Sustaining Treatment (POLST): Similar to MOLST, POLST is a medical document that translates a patient's wishes into actual physician orders. It ensures that the medical team is aware of the patient’s goals and preferences, much like a DNR Order.
  • Advance Healthcare Directive: This document combines a living will and a durable power of attorney, allowing individuals to specify medical treatment preferences and appoint someone to carry them out. Like the DNR, it emphasizes a person's choices about their care.

Understanding these documents can help individuals communicate their healthcare wishes clearly, ensuring that their preferences are respected. It’s always advisable to discuss these options with loved ones and healthcare providers to ensure all parties are informed and prepared.

Dos and Don'ts

When filling out the Colorado Do Not Resuscitate Order form, it's important to follow specific guidelines to ensure that your wishes are properly documented and respected. Here are some key points to consider:

  • Do: Clearly indicate your wishes regarding resuscitation.
  • Do: Ensure that the form is signed and dated by you or your authorized representative.
  • Do: Keep a copy of the completed form for your records.
  • Do: Share your wishes with your healthcare providers and family members.
  • Don’t: Leave any sections of the form blank, as this can lead to confusion.
  • Don’t: Forget to include your contact information.
  • Don’t: Assume that verbal instructions are enough; always provide a written order.
  • Don’t: Ignore state-specific regulations and requirements related to the form.

Misconceptions

When it comes to healthcare decisions, particularly regarding life-saving measures, many people have serious misconceptions about the Colorado Do Not Resuscitate (DNR) Order form. Understanding these common myths can help ensure that individuals make informed choices. Here are seven misconceptions that often arise:

  • A DNR means you will not receive any medical care. This is false. A DNR specifically addresses resuscitation efforts in the event of cardiac arrest, but it does not indicate that other forms of medical treatment will be withheld.
  • Only terminally ill patients can have a DNR. This misconception overlooks the fact that anyone can choose to have a DNR order, regardless of their health status. A DNR is about personal choice and values concerning end-of-life care.
  • If I have a DNR, I will not be treated painlessly. Incorrect. Healthcare providers prioritize comfort and palliative care for all patients, including those with DNR orders. The focus shifts to quality of life rather than the aggressive prolonging of life.
  • A DNR is permanent and cannot be changed. In reality, a DNR can be revoked or altered at any time. Individuals have the right to reassess their decisions as circumstances change.
  • My family can override my DNR wishes. While family members may have strong opinions, a legally executed DNR order typically takes precedence over verbal requests or family wishes, provided that the order complies with state laws.
  • Healthcare providers will ignore my DNR if I am admitted to the hospital. This is not true. When a DNR is nominated and presented correctly, it must be honored across medical settings, including hospitals. Communication is vital, though, to ensure everyone is aware of the order.
  • DNR orders only apply to emergencies. This is misleading. While DNR orders focus on emergencies, they are also part of broader advance care planning discussions. They should be understood within the context of overall healthcare preferences and end-of-life wishes.

Addressing these misconceptions can empower individuals to make informed choices regarding their medical care and ensure that their wishes are respected. Having clear discussions with healthcare providers and family members about DNR orders is crucial to achieving peace of mind.

Key takeaways

Here are some important points to consider when filling out and using the Colorado Do Not Resuscitate Order (DNR) form:

  1. The DNR form is a medical directive that allows individuals to refuse cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
  2. Only a licensed physician can sign the DNR form, confirming the patient's wishes and medical condition.
  3. The form must be completed and signed by both the patient (or their legal representative) and the healthcare provider.
  4. It is crucial to ensure that the patient fully understands the implications of having a DNR order in place.
  5. The completed DNR form should be placed in a visible location, such as on the refrigerator or bedside table.
  6. A copy of the DNR order should be given to all healthcare providers involved in the patient’s care.
  7. Patients can change or revoke their DNR order at any time; a new form must be completed for any changes.
  8. The DNR order is only effective in emergency situations where resuscitation measures are indicated.
  9. Respecting the wishes of the patient is paramount; inform family members about the DNR order to avoid confusion during emergencies.
  10. Consulting with a healthcare professional can provide clarity on how a DNR order fits into the patient's overall care plan.

Being informed is essential for both patients and their loved ones when considering a DNR order. Understanding the purpose and process can ensure that wishes are honored in times of medical crisis.

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