Attorney-Verified  Do Not Resuscitate Order Form for Ohio

Attorney-Verified Do Not Resuscitate Order Form for Ohio

The Ohio Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding medical care in the event of a cardiac or respiratory arrest. By completing this form, you can communicate your desire to forgo resuscitation measures, ensuring that your preferences are honored during critical moments. To take control of your healthcare decisions, consider filling out the form by clicking the button below.

Content Overview

The Ohio Do Not Resuscitate Order form plays a crucial role in ensuring patients' medical preferences are respected in emergency situations. This document serves as a clear indicator of an individual's wishes regarding resuscitation efforts, allowing medical personnel to understand and adhere to those wishes during critical moments. Patients can express their desire to forgo cardiopulmonary resuscitation (CPR) if their heart stops or if they stop breathing. The form includes fields for essential information, such as the patient's name, date of birth, and signature, along with the signature of a physician or other authorized healthcare provider. It is important to note that this form must be completed and signed to be legally binding. Furthermore, the Do Not Resuscitate Order is intended to guide emergency responders and healthcare professionals, ensuring that care reflects the patient's values and choices. Understanding the implications of this form is vital for both patients and their families, as it initiates important conversations about end-of-life care and personal health decisions.

Ohio Do Not Resuscitate Order Sample

Ohio Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order (DNR) is a legally binding document created under Ohio law. It indicates the preference of the individual regarding cardiopulmonary resuscitation (CPR) and other life-sustaining procedures in the event of a medical emergency.

Patient Information:

  • Name: ___________________________
  • Date of Birth: ___________________
  • Social Security Number: __________
  • Address: _________________________

Declaration:

I, the undersigned, declare that if my heart stops beating or if I stop breathing, I do not want CPR or other resuscitation attempts. This order is made voluntarily and reflects my wishes.

Health Care Representative:

If I am unable to communicate my wishes, I designate the following person as my health care representative:

  • Name: ___________________________
  • Relationship: ____________________
  • Phone Number: ___________________

Signature:

By signing below, I confirm that I understand my rights and the implications of this Do Not Resuscitate Order.

Signature of Patient: ___________________________

Date: _______________

Witness Signature:

Witness Name: _________________________________

Date: _______________

This document should be kept in a place where it can be easily accessed by health care providers and family members. It may be shared with any medical professional, facility, or emergency medical services personnel.

For more information, please refer to Ohio Revised Code, Section 2133.21 et seq.

PDF Specifications

Fact Name Description
Purpose The Ohio Do Not Resuscitate (DNR) Order form allows individuals to decline cardiopulmonary resuscitation (CPR) in the event of a medical emergency.
Eligibility Any adult who is competent or a minor with parental consent can complete the DNR Order form.
Governing Law Ohio law specifically governs the DNR Order provisions under Section 2133.21 of the Ohio Revised Code.
Form Availability The Ohio DNR Order form is available through healthcare providers, hospitals, and the Ohio Department of Health.

Ohio Do Not Resuscitate Order: Usage Instruction

Filling out the Ohio Do Not Resuscitate Order form is an important step for individuals who want to ensure their preferences about medical treatment are known. This process requires careful attention to detail to ensure that the form is completed accurately and understood by healthcare providers.

  1. Obtain the Ohio Do Not Resuscitate Order form. You can find it on the Ohio Department of Health website or receive a physical copy from your physician.
  2. Fill in the patient's full name and date of birth at the top of the form.
  3. Indicate the patient's address. Provide the complete residential address, including city and zip code.
  4. Sign and date the form. Ensure it is signed by the patient or their legal representative.
  5. Have the patient's physician sign the form. The physician must also print their name and provide their contact information.
  6. Keep copies of the signed form for personal records. It’s essential to have copies easily accessible for healthcare providers.
  7. Provide a copy of the signed DNR form to your healthcare providers. Make sure it’s included in your medical records for reference during emergencies.

Once the form is filled out, ensure that all parties involved are informed about the patient's wishes. Regular communication can help everyone understand and respect the decisions made. It's also a good idea to review the document periodically and update it if any changes occur in the patient's health or preferences.

Frequently Asked Questions

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

    A Do Not Resuscitate (DNR) Order is a legal document in Ohio that allows patients to refuse CPR (cardiopulmonary resuscitation) and other lifesaving measures in the event of a cardiac arrest or respiratory failure. This document is typically utilized by individuals with severe health issues or terminal conditions who wish to pass in a natural manner without the interference of life-sustaining interventions.

  2. Who can create a DNR Order in Ohio?

    In Ohio, a DNR Order can be created by an adult who is of sound mind. Additionally, a parent or legal guardian can create a DNR for a minor. It is essential that the individual understands the implications of the DNR Order and that their decision is voluntary.

  3. How is a DNR Order completed in Ohio?

    To complete a DNR Order, an individual must fill out the official DNR form provided by the Ohio Department of Health. The form requires the patient's information along with a signature. It is important that the order is signed by a physician or another authorized healthcare provider to be legally valid.

  4. Is a DNR Order valid in all healthcare settings?

    Yes, once properly completed and signed, a DNR Order is valid in various healthcare settings across Ohio, including hospitals, nursing homes, and private residences. However, it’s crucial to ensure that copies of the DNR are easily accessible to healthcare providers in case of an emergency.

  5. Can I change or revoke my DNR Order?

    Certainly! Individuals have the right to change or revoke their DNR Order at any time. To do this, you must communicate the change to your healthcare providers and ensure that an updated DNR form is completed, if necessary. Simply destroying the original document, such as tearing it up, will also suffice to revoke it.

  6. What if I change my mind about my DNR Order?

    If you change your mind about your DNR Order, you can certainly inform your healthcare providers that you want to receive all lifesaving measures. It’s vital to keep your medical team updated about your wishes to ensure they align with your current desires.

  7. Are there any differences between a DNR Order and an advance directive?

    Yes, while both documents relate to end-of-life care, a DNR Order specifically addresses resuscitation decisions, while an advance directive encompasses a broader range of healthcare decisions, including appointing a healthcare proxy and outlining preferences for treatment in various medical situations.

  8. What should I do with my DNR Order once it’s completed?

    After completing your DNR Order, keep the original document in a safe yet accessible place. Make sure family members, caregivers, and healthcare providers are informed of its location. Consider discussing your DNR wishes with your loved ones to ensure everyone understands your decisions and respects them.

Common mistakes

Completing a Do Not Resuscitate (DNR) Order in Ohio is a crucial process that allows individuals to express their wishes regarding medical interventions in life-threatening situations. However, many people inadvertently make mistakes that can affect the validity of the order or lead to confusion at critical moments. Understanding these common pitfalls can help ensure that your wishes are honored when it matters most.

One frequent mistake involves failing to have the form properly signed. A DNR Order must be signed by the patient, or a legally authorized representative, to be valid. In Ohio, the signature must not only come from the individual but should also be accompanied by a physician's signature. Without these essential signatures, medical personnel may not be able to respect the wishes expressed in the document. This necessary step may seem simple, yet its oversight can result in unnecessary resuscitation efforts.

Another common error is neglecting to communicate the existence of the DNR Order to family members and medical staff. Leaving loved ones in the dark can create confusion and stress during an already challenging time. Distributing copies of the DNR document to key family members and placing it in visible locations, like the refrigerator or a bedside table, ensures that everyone involved is aware of the individual’s wishes. Being proactive about communication can save everyone from heartache and misunderstandings later.

Additionally, people sometimes underestimate the importance of reviewing and updating the DNR Order regularly. Life circumstances, health conditions, and personal wishes may change over time. An outdated form might not accurately reflect a person’s current wishes, leading healthcare providers to make decisions contrary to what the patient would want. Setting a reminder to revisit the DNR Order, perhaps annually or following significant life changes, can help keep the document aligned with an individual's values and preferences.

Lastly, many individuals might overlook the need for clarity in the language used on the DNR form. Vague language can lead to confusion for healthcare providers who are trying to interpret the orders under pressure. Instead of generic statements, providing clear, explicit instructions can help ensure that medical staff understand the wishes without ambiguity. This clarity helps minimize the risk of unintended interventions in critical situations.

Documents used along the form

The Ohio Do Not Resuscitate (DNR) Order is an important document that allows individuals to express their wishes regarding medical treatment in emergency situations. However, it is often accompanied by other forms that help clarify or support these wishes. Below are some key forms and documents that are frequently used alongside the Ohio DNR Order.

  • Advance Directive: This document outlines a person's healthcare preferences and may include specific instructions about medical treatment. It can also designate a healthcare proxy—someone who makes decisions on the patient's behalf if they are unable to do so.
  • Medical Power of Attorney: This legal form allows an individual to appoint someone to make healthcare decisions for them if they become incapacitated. It is vital for ensuring that a person's preferences are respected when they cannot communicate.
  • POLST (Physician Orders for Life-Sustaining Treatment): A POLST form provides clear medical orders regarding a patient's treatment preferences. It is intended for individuals with serious illnesses and must be signed by a physician to be valid.
  • Living Will: This document details a person's wishes regarding end-of-life care and interventions they do or do not want. It is not the same as a DNR but can provide important context for healthcare providers and family members.

These forms work together to ensure that an individual's healthcare wishes are clear and respected, especially in critical situations. Being informed about these documents can help facilitate essential discussions with family and healthcare providers.

Similar forms

A Do Not Resuscitate (DNR) Order is an important legal document that indicates a person's wishes regarding resuscitation efforts in case of a medical emergency. Similar documents serve various purposes in managing health care preferences. Here are seven documents that share similarities with a DNR order:

  • Living Will: This document outlines an individual's preferences for medical treatment in the event they are unable to communicate. Like a DNR, it helps healthcare providers understand a patient's wishes.
  • Healthcare Power of Attorney: Also known as a healthcare proxy, this allows someone to make medical decisions on behalf of another person. It complements a DNR by designating a trusted individual to ensure the DNR is honored.
  • Advance Directive: This is an umbrella term that includes both living wills and healthcare powers of attorney. It provides clear guidance on what a patient wants for their medical care, including resuscitation preferences.
  • Physician Orders for Life-Sustaining Treatment (POLST): Similar to a DNR, this document contains medical orders based on a patient's preferences for treatment, and it is signed by a healthcare provider, making it actionable in emergencies.
  • Do Not Intubate Order: This specifies that a patient does not wish to be intubated in case of respiratory failure. It often accompanies a DNR, reinforcing preferences for specific interventions.
  • Comfort Care Order: This document emphasizes palliative care rather than aggressive treatment. It is aligned with the philosophy of a DNR by focusing on comfort rather than resuscitation.
  • End-of-Life Care Plan: This comprehensive document details a person's wishes regarding end-of-life care, including medical, emotional, and spiritual considerations, similar to a DNR in prioritizing patient-centered decisions.

Dos and Don'ts

When filling out the Ohio Do Not Resuscitate Order form, it’s crucial to understand what to do and what to avoid. Here’s a simple list to guide you:

  • Do: Make sure your preferences are clearly stated.
  • Do: Discuss your wishes with your healthcare provider and family.
  • Do: Sign and date the form appropriately.
  • Do: Keep copies of the form in accessible locations.
  • Don't: Forget to review the form regularly; your wishes may change.
  • Don't: Leave blanks—ensure all sections are completed.
  • Don't: Assume healthcare personnel will know your wishes without the form.
  • Don't: Misplace the document; ensure it’s easily found by loved ones or caregivers.

Misconceptions

Understanding the Ohio Do Not Resuscitate (DNR) Order form can be complex. Here are some common misconceptions about it:

  1. A DNR Order means I will not receive any medical care. This is not true. A DNR only means that emergency medical personnel will not perform CPR if a cardiac arrest occurs. Other medical treatments and care can still be provided.
  2. Only terminally ill patients can have a DNR Order. This is a misconception. Anyone can choose to have a DNR order, regardless of their health status. It simply reflects personal preferences regarding resuscitation.
  3. Once I sign a DNR form, I can’t change my mind. This is incorrect. A DNR order can be revoked at any time. If your preferences change, you can inform medical personnel and rescind the order.
  4. The DNR Order is only valid in a hospital. This is misleading. The DNR Order is valid in both hospital and out-of-hospital settings. It is important that the form is clearly displayed or communicated in any situation.
  5. I need a lawyer to create a DNR Order. This is not necessary. While legal advice can be helpful, individuals can complete a DNR order on their own, following the proper state guidelines.
  6. DNR Orders are only recognized in Ohio. This is a misconception. While DNR laws differ by state, a properly executed Ohio DNR order is generally honored in other states, though it’s a good idea to check local laws.
  7. Having a DNR Order means I'm giving up on life. This is a common belief, but it’s not true. A DNR order is about making choices that align with one’s personal values and wishes regarding end-of-life care.

Key takeaways

  • The Ohio Do Not Resuscitate (DNR) Order form allows individuals to express their wishes regarding resuscitation efforts in emergency medical situations.

  • It is important to complete the form accurately and to keep it in a place where it is easily accessible to emergency responders, such as on a refrigerator or with personal medical records.

  • The DNR Order must be signed by the patient or their legal representative, along with the signature of a physician to be considered valid.

  • Once the DNR Order is in place, it is advisable to discuss the decision with family members and healthcare providers to ensure everyone understands the patient’s preferences.

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