Attorney-Verified  Do Not Resuscitate Order Form for Illinois

Attorney-Verified Do Not Resuscitate Order Form for Illinois

An Illinois Do Not Resuscitate Order (DNRO) form is a legal document that allows individuals to indicate their wishes regarding resuscitation efforts in case of cardiac arrest or respiratory failure. This form communicates a person's decision to forgo life-saving measures, ensuring that medical staff honors their preferences during emergencies. Understanding and filling out this form can provide peace of mind; click the button below to get started.

Content Overview

In Illinois, the Do Not Resuscitate (DNR) Order form serves a critical role in ensuring that individuals' medical preferences are respected in urgent situations. This legal document allows patients to communicate their wish to forego resuscitation efforts in the event of cardiac arrest or respiratory failure. Clear guidelines govern the use of the DNR form, emphasizing the importance of patient autonomy and informed consent. It must be signed by both the patient and their physician, affirming that the patient fully understands the implications of the decision. The form should be easily accessible, often kept on the refrigerator or near the bedside, so that medical personnel can promptly find it when necessary. A properly executed DNR Order can foster peace of mind for both individuals and their loved ones, knowing that their choices regarding end-of-life care will be honored. Awareness of the requirements, including the signing process and proper storage, is crucial for anyone considering this option, ensuring that their healthcare wishes are clear and legally enforceable.

Illinois Do Not Resuscitate Order Sample

Illinois Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is created in accordance with Illinois state law, specifically the Illinois DNR law.

Please fill out the information below:

  1. Patient's Name: ____________________________
  2. Date of Birth: ____________________________
  3. Address: _________________________________
  4. City: ____________________________________
  5. State: ___________ Zip Code: _____________

This order indicates that the patient does not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. The healthcare professional should honor this decision.

Signature of Patient or Authorized Decision Maker: ____________________________

Printed Name of Authorized Decision Maker: _________________________________

Relationship to Patient: ________________________________________________

Date of Signature: ______________________

This document should be placed in a prominent location, such as the patient's medical records, and copies should be given to the patient's healthcare providers and family members.

For more information about this order, please refer to the Illinois Compiled Statutes.

PDF Specifications

Fact Name Description
Legal Authority The Illinois Do Not Resuscitate Order form is governed by the Illinois Compiled Statutes, specifically 755 ILCS 35.
Purpose This form allows individuals to specify their wishes regarding resuscitation efforts in the event of cardiac arrest.
Eligibility Any adult can complete this form, as well as a parent or guardian for a minor who wishes to refuse resuscitation.
Signature Requirements The form must be signed by the individual or their authorized representative and must also be witnessed by two individuals or notarized.
Recognition by Medical Personnel Health care providers in Illinois are required to honor a valid DNR order, and failure to do so may result in legal consequences.

Illinois Do Not Resuscitate Order: Usage Instruction

Completing the Illinois Do Not Resuscitate Order form is a significant step for individuals who wish to define their medical treatment preferences. By taking this action, one can ensure that healthcare providers are aware of their wishes in situations where resuscitation might be required. Following a clear set of steps will facilitate the completion of this important document.

  1. Obtain the Illinois Do Not Resuscitate Order form. This can typically be found online through the Illinois Department of Public Health or your healthcare provider.
  2. Read the form carefully to understand its purpose and the implications of your choices.
  3. Fill in your full legal name in the designated section at the top of the form.
  4. Provide your date of birth and any relevant identification information, such as a driver's license number or Social Security number.
  5. Indicate your preferences regarding resuscitation clearly and distinctly in the appropriate section.
  6. Include the name and contact information of your physician who is involved in your care. This step is crucial for validation of the form.
  7. Sign and date the form. It is essential that you do this in the presence of a qualified witness.
  8. Have a witness sign the form. The witness must be someone who is not related to you or a person entitled to any part of your estate.
  9. Make copies of the signed document for your personal records and distribute additional copies to your healthcare provider and family members.

Frequently Asked Questions

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

    A Do Not Resuscitate Order is a legal document that indicates a person's wish to forgo resuscitation in the event of a medical emergency. This means that if the individual stops breathing or their heart stops beating, medical personnel will not take measures to restart their heart or breathing. The DNR order must be created in compliance with state laws and should be signed by the patient and their physician.

  2. Who can create a DNR Order?

    In Illinois, any adult who is capable of making informed health care decisions can create a DNR order. This includes individuals who have the legal capacity to understand the implications of their choice. If a person is unable to make decisions, a legally authorized representative or an appointed guardian can create the order on their behalf.

  3. How is a DNR Order implemented?

    The DNR order must be signed by both the patient and a physician. It then becomes part of the individual’s medical record. Upon its creation, copies should be provided to relevant healthcare providers, and the patient or their representative should keep a copy as well. It’s important to ensure that medical staff are aware of the order when necessary.

  4. Can a DNR Order be revoked?

    Yes, a DNR order can be revoked at any time by the individual who created it. Revocation can be done verbally or through a new written order that explicitly states the desire to cancel the DNR. It is essential to inform all relevant healthcare providers of the change to ensure that the new instructions are followed.

  5. Is a DNR Order valid in every healthcare setting?

    Generally, a DNR order is valid in most healthcare settings, including hospitals, nursing homes, and at home. However, it is crucial to confirm that the order is recognized by the specific facility or provider. Some institutions may have additional policies or forms that need to be filled out, so checking ahead is advisable.

  6. What should I consider before creating a DNR Order?

    Before creating a DNR order, consider your values and preferences regarding end-of-life care. Discuss your wishes with family members, healthcare providers, and loved ones to ensure everyone understands your choices. It's also wise to consult with legal or healthcare professionals to fully understand your options and the implications of a DNR order.

Common mistakes

When filling out the Illinois Do Not Resuscitate Order (DNR) form, many individuals make common mistakes that can have serious implications. Understanding these pitfalls is crucial for ensuring your wishes are clearly communicated and honored. Here are seven mistakes to avoid.

First, many people fail to clearly state their intentions. A vague or ambiguous response can lead to confusion. Be specific about your desires for resuscitation or aggressive medical treatment. When in doubt, consider discussing these wishes with a healthcare provider who can offer clarity.

Second, incomplete information is a frequent error. The form requires necessary details, such as your name, date of birth, and preferred medical interventions. Omitting any of these can delay your wishes from being honored. Always double-check that every section is filled out completely.

Third, individuals often forget to sign the form. A signature is crucial for the DNR to be valid. Without it, medical personnel may not regard the order. Ensure you go through the final step and have it signed, preferably in the presence of a witness.

Another mistake is neglecting to date the document. The date is important as medical personnel may need to verify that the DNR order is current. An undated form can complicate matters, leading to unnecessary interventions. Make sure to write the date clearly when you sign.

Fifth, people sometimes use outdated forms or versions. Illinois may update its regulations or forms, and using the wrong one can lead to complications. Always confirm that you have the most current version available from a reliable medical or legal source.

Additionally, failing to share the completed DNR form with family members and healthcare providers is a significant oversight. Your loved ones should know your wishes and where the document is located. This allows them to advocate on your behalf should the need arise.

Lastly, do not forget to review and revise your DNR order over time. Life circumstances can change, and your healthcare preferences may shift as well. Regularly assess your DNR to ensure it aligns with your current beliefs and desires.

By being aware of these common mistakes, you can help ensure that your preferences regarding medical treatment are respected. Take the time to complete your DNR order accurately, and you will provide yourself peace of mind.

Documents used along the form

The Illinois Do Not Resuscitate (DNR) Order form is an important document that allows individuals to express their wishes regarding medical treatment in life-threatening situations. Alongside the DNR, there are several other forms and documents you may encounter that facilitate healthcare decisions. Below is a list of relevant documents that complement the DNR Order in providing clarity regarding medical care preferences.

  • Advance Directive: This document outlines a person's wishes regarding medical treatment when they can no longer communicate their preferences. It can cover various scenarios beyond resuscitation, including the use of ventilators and feeding tubes.
  • Power of Attorney for Healthcare: This form designates a specific individual to make healthcare decisions on behalf of the person. It provides guidance on treatments preferred or avoided, ensuring that the appointed person understands the patient's wishes.
  • Living Will: A living will specifies the types of medical treatment an individual desires or refuses in case they are unable to communicate. It often addresses end-of-life care and other significant medical interventions.
  • MOLST (Medical Orders for Life-Sustaining Treatment): This is a medical document that provides specific orders for treatment options. It is often used in medical settings to ensure that healthcare providers follow the patient's treatment preferences.
  • HIPAA Authorization Form: This document allows individuals to authorize specific individuals to access their medical records. It ensures that families or caregivers can receive necessary information at critical times.
  • Patient Preference Documentation: This form outlines a patient's specific medical preferences and values, providing healthcare providers with insights into what matters most to the individual in their care journey.

These documents work together to ensure that individuals' healthcare preferences are clear, respected, and followed. Familiarity with these forms can significantly aid families and healthcare professionals in making informed decisions that honor the wishes of patients.

Similar forms

When considering end-of-life choices, individuals often encounter various documents similar to a Do Not Resuscitate (DNR) Order. Each serves a specific purpose related to healthcare decisions. Here’s a brief overview of eight such documents:

  • Advance Healthcare Directive: This document allows individuals to outline their healthcare preferences and appoint someone to make decisions on their behalf if they are unable to do so.
  • Living Will: A living will details specific medical treatments an individual wishes or does not wish to receive in situations where they cannot communicate their wishes.
  • Healthcare Proxy: This designation allows a person to select a trusted individual to make medical decisions for them in case they become incapacitated.
  • Power of Attorney for Healthcare: This document grants someone the authority to make healthcare decisions and manage medical treatment based on the principles outlined in the advance healthcare directive.
  • Do Not Intubate (DNI) Order: Similar to a DNR, a DNI indicates that a patient does not wish to be intubated or placed on a ventilator during a medical emergency.
  • Palliative Care Plan: This plan focuses on comfort and quality of life for patients with serious illnesses, emphasizing care goals rather than curative measures.
  • Out-of-Hospital Do Not Resuscitate Order: This specialized DNR applies outside medical facilities, instructing emergency responders not to initiate resuscitation efforts in case of cardiac arrest.
  • POLST (Physician Orders for Life-Sustaining Treatment): This form translates an individual's wishes regarding life-sustaining treatments into a medical order, ensuring that healthcare providers follow those preferences.

Each of these documents plays a critical role in communicating personal health care preferences and can work in tandem with a DNR to provide comprehensive guidance for medical staff and loved ones.

Dos and Don'ts

When filling out the Illinois Do Not Resuscitate (DNR) Order form, it is important to approach the process with care. Below are some recommended actions and common pitfalls to avoid:

  • Do ensure you have a clear understanding of the DNR concept. Familiarize yourself with what a DNR order entails and its implications.
  • Don't rush the process. Take your time to consider your decisions and consult with family or healthcare providers if necessary.
  • Do include accurate personal information. Fill out your name, date of birth, and other required details correctly.
  • Don't overlook your signature. Make sure to sign and date the form to validate your wishes.
  • Do discuss your choices with your healthcare provider. Engage in a conversation about your medical condition and treatment preferences.
  • Don't forget to keep copies of the completed form. Make sure to provide copies to your healthcare team and family members.
  • Do review the form periodically. Consider updating your wishes as your health or circumstances change.

Being informed and following these guidelines can help ensure your wishes are respected and understood.

Misconceptions

When it comes to Do Not Resuscitate (DNR) Orders in Illinois, there are several misconceptions that can lead to confusion. Understanding the facts can help individuals and their loved ones make informed decisions about their healthcare. Here are some common misconceptions:

  • A DNR order means no medical care at all. This is not true. A DNR order specifically instructs healthcare providers not to perform resuscitation procedures in the event of cardiac arrest. However, it does not prevent individuals from receiving other types of medical care or treatment.
  • Once a DNR is signed, it cannot be changed or revoked. In fact, individuals have the right to change their minds at any time. A DNR order can be revoked verbally or in writing, and healthcare providers must recognize a patient’s wishes.
  • DNR orders are only for terminally ill patients. While many people associate DNR orders with end-of-life scenarios, they can be appropriate for anyone who wishes to forgo resuscitation, regardless of their overall health status. Each person’s decision should be based on their values and wishes.
  • Having a DNR means healthcare providers will not treat you. This is a misconception. Healthcare providers are still obligated to provide care and relief measures, such as pain management and comfort care, even when a DNR is in place.
  • A DNR order is only valid if it is on a specific form. While it is advisable to use the Illinois Do Not Resuscitate Order form, a valid DNR can also be documented in other formats or healthcare documents, such as advance directives. What matters is that it clearly expresses the patient’s wishes.
  • You need a lawyer to create a DNR order. Creating a DNR order does not require legal assistance. Instead, individuals can discuss their wishes with their healthcare provider to ensure that their preferences are documented correctly. It's part of being proactive in your healthcare planning.

Understanding these misconceptions can empower individuals to discuss their healthcare preferences openly. It’s important to have these conversations with loved ones and medical professionals for clarity and peace of mind.

Key takeaways

When considering the Illinois Do Not Resuscitate (DNR) Order form, it is essential to understand the implications and proper procedures surrounding its use. Below are key takeaways to keep in mind.

  1. Understanding the Purpose: The DNR Order is a legal document that instructs medical professionals not to perform cardiopulmonary resuscitation (CPR) if a person stops breathing or their heart stops beating.
  2. Eligibility: The form is intended for adults who are seriously ill or injured and wish to avoid aggressive resuscitation measures that may not align with their healthcare preferences.
  3. Discuss with Healthcare Providers: It is crucial to have conversations with medical professionals regarding DNR preferences to ensure that everyone involved understands the individual’s wishes.
  4. Form Access: The Illinois DNR Order form can typically be obtained through healthcare providers, hospitals, or online resources specific to Illinois health services.
  5. Completing the Form: The form must be filled out completely and signed, including signatures from a physician and the person making the request or their legal representative.
  6. Distributing Copies: After completing the form, share copies with family members, healthcare providers, and ensure that it is placed in a location accessible to emergency medical services.
  7. Review Periodically: It is advisable to review the DNR Order periodically to ensure it still reflects the person's wishes and update the form if one's healthcare preferences change.

By understanding these key aspects of the Illinois Do Not Resuscitate Order form, individuals can make informed decisions regarding their end-of-life care preferences.

Browse More Do Not Resuscitate Order Forms for Specific States