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Attorney-Approved Washington Do Not Resuscitate Order Form

A Washington Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to refuse resuscitation efforts in the event of a medical emergency. This form is an important tool for expressing personal wishes about end-of-life care. Understanding how to complete this form can provide peace of mind for both individuals and their loved ones.

If you are considering filling out a DNR Order, please take the time to complete the form by clicking the button below.

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The Washington Do Not Resuscitate (DNR) Order form is an essential document for individuals who wish to express their preferences regarding emergency medical treatment in the event of a life-threatening situation. This form allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures if their heart stops or they stop breathing. It is crucial for ensuring that medical personnel understand and respect a patient's wishes during critical moments. The DNR form must be completed and signed by the patient or their authorized representative, and it typically requires a physician's signature to validate the request. In Washington, the form is recognized across various healthcare settings, ensuring that the patient's choices are honored consistently. Understanding the implications of a DNR order is vital, as it can significantly impact end-of-life care and the overall treatment approach in emergencies. By having this conversation and completing the form, individuals can take control of their healthcare decisions, ensuring that their values and preferences are respected even when they cannot speak for themselves.

Instructions on How to Fill Out Washington Do Not Resuscitate Order

Filling out the Washington Do Not Resuscitate Order (DNR) form is an important step in expressing your healthcare preferences. This document allows you to communicate your wishes regarding resuscitation efforts in case of a medical emergency. Here’s how to complete the form effectively.

Obtain the Washington Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
Carefully read the instructions provided on the form to ensure you understand what is required.
Fill in your full name, date of birth, and any other identifying information requested at the top of the form.
Indicate your decision regarding resuscitation by checking the appropriate box. Make sure this reflects your wishes accurately.
If applicable, have your healthcare provider complete the section that requires their signature and contact information. This step is essential for the form to be valid.
Sign and date the form yourself. Your signature confirms that you understand and agree with the contents of the document.
Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and any family members involved in your care.

Once you've filled out the form, make sure to discuss your wishes with your loved ones and healthcare team. This ensures everyone is aware of your preferences and can act accordingly in a medical situation.

Key takeaways

Filling out and using the Washington Do Not Resuscitate (DNR) Order form is an important step in ensuring that your healthcare preferences are respected in emergency situations. Here are some key takeaways to consider:

The DNR order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing.
To create a valid DNR order in Washington, you must be an adult and capable of making your own healthcare decisions.
The form must be signed by both you and your healthcare provider to be legally binding.
It is important to discuss your wishes with your healthcare provider before filling out the form to ensure that you understand the implications.
You should keep the DNR order in a place that is easily accessible, such as with your medical records or on your refrigerator.
Make sure to inform family members and caregivers about your DNR order so they can support your wishes.
The DNR order can be revoked at any time. You can do this verbally or by destroying the form.
Review your DNR order periodically, especially if your health status changes or if you have new healthcare providers.

Some Other Do Not Resuscitate Order State Templates

California Dnr - Individuals who are mentally competent have the right to make their own DNR decisions.

Is a Dnr an Advance Directive - Informing your healthcare provider of a DNR order is critical for ensuring that your wishes are followed even if you can't speak.

Is a Dnr an Advance Directive - Having a DNR order can alleviate the burden on family members during crises.

Documents used along the form

When considering a Washington Do Not Resuscitate (DNR) Order, it's essential to understand that this document often works in conjunction with other important forms. These documents help ensure that your healthcare preferences are clearly communicated and respected. Below are four common forms that are frequently used alongside a DNR Order.

Advance Healthcare Directive: This document allows individuals to outline their healthcare preferences in advance. It often includes instructions about medical treatments and appoints a healthcare agent to make decisions if the individual becomes unable to communicate their wishes.
Durable Power of Attorney for Healthcare: This form designates a trusted person to make medical decisions on behalf of the individual when they are incapacitated. It is crucial for ensuring that someone who understands your values and wishes can advocate for you during critical times.
Physician Orders for Life-Sustaining Treatment (POLST): A POLST form provides specific medical orders regarding life-sustaining treatments. Unlike a DNR, which focuses solely on resuscitation, a POLST addresses a broader range of medical interventions based on the individual's health status and preferences.
Living Will: This document specifies the types of medical treatment an individual wishes to receive or avoid in situations where they cannot communicate their preferences. It serves as a guide for healthcare providers and loved ones during difficult times.

Understanding these forms can empower individuals to make informed choices about their healthcare. By having these documents in place, you can ensure that your wishes are honored, providing peace of mind for both you and your loved ones.

Sample - Washington Do Not Resuscitate Order Form

Washington Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order (DNR) is established in accordance with Washington state laws regarding advance medical directives. It allows individuals to express their preferences regarding resuscitation efforts in the event of a medical emergency.

By filling out this form, the undersigned acknowledges the intention to not receive resuscitative measures such as cardiopulmonary resuscitation (CPR) or other life-sustaining interventions.

Patient Information

Patient Name: ___________________________
Date of Birth: ______________________
Address: ____________________________
City, State, Zip: ____________________________

Personal Representative Information (if applicable)

Name: ___________________________
Relationship to Patient: ______________________
Contact Number: ______________________

Statement of Wishes

I, the undersigned, wish for the following regarding resuscitation:

No resuscitative measures, including CPR, shall be taken in case of cardiac or respiratory arrest.
This decision is made after careful consideration of my health status and personal values.
I understand that this order may be revoked at any time.

Signatures

This DNR order must be signed in the presence of a witness to be valid.

Signature of Patient: ___________________________
Date: ___________________________

Witness Name: ___________________________

Witness Signature: ___________________________

Date: ___________________________

It is recommended to keep copies of this document in accessible locations, such as with your primary healthcare provider and any hospitals where you receive treatment.

Dos and Don'ts

When filling out the Washington Do Not Resuscitate Order form, it is essential to follow specific guidelines to ensure that your wishes are clearly communicated. Here are six important do's and don'ts to consider:

Do ensure that the form is completed in full, providing all required information.
Do discuss your wishes with your healthcare provider and family members.
Do keep a copy of the completed form in a visible location, such as on your refrigerator.
Do sign and date the form to validate it.
Don't use a form that has not been officially recognized by the state of Washington.
Don't assume that verbal instructions will suffice; written documentation is necessary.