Attorney-Verified  Do Not Resuscitate Order Template for Ohio Launch Editor

Attorney-Verified Do Not Resuscitate Order Template for Ohio

The Ohio Do Not Resuscitate Order form, commonly referred to as a DNR, is a legal document that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event a patient's breathing or heartbeat stops. This directive ensures that medical personnel respect the wishes of individuals who choose not to undergo potentially aggressive interventions at the end of life. As such, it stands as a critical tool for those seeking to maintain control over their healthcare decisions in their final moments.

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In Ohio, individuals have the right to make decisions about the medical care they wish to receive at the end of their lives, including the choice not to undergo certain life-sustaining treatments. A critical tool in ensuring these decisions are respected is the Do Not Resuscitate (DNR) Order form. This legal document allows individuals to declare their preference not to have cardiopulmonary resuscitation (CPR) in the event their breathing stops or their heart ceases to beat. The DNR Order is designed to respect patient autonomy by allowing them to refuse treatment that they deem undesirable in their final moments. It is a sensitive subject, requiring careful consideration and discussions with healthcare providers and loved ones to ensure that one's wishes are clearly understood and followed. Through this form, Ohio residents have the means to communicate their end-of-life care preferences clearly and effectively, making it an essential aspect of healthcare planning and patient rights.

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This Ohio Do Not Resuscitate (DNR) Order is created in accordance with the Ohio Revised Code 2133.21-.26, relating specifically to Do Not Resuscitate orders within the State of Ohio. The purpose of this document is to instruct healthcare professionals not to perform cardiopulmonary resuscitation (CPR) in the event of a patient's cardiac or respiratory arrest. This document only becomes effective under the circumstances specified herein and should be used only by the individual, or a legally authorized representative, named below after careful consideration and consultation with a healthcare provider.

Please provide the following information:

  • Patient's Full Name: ________________________________
  • Date of Birth: ________________________
  • Address: ___________________________________________
  • Primary Physician's Name: ___________________________
  • Primary Physician's Contact Information: ______________

By signing this Ohio Do Not Resuscitate Order, I (or my legally authorized representative) acknowledge that:

  1. I have discussed my health condition and the implications of a Do Not Resuscitate Order with a healthcare provider. I understand that this decision will prevent the use of CPR in the event of cardiac or respiratory arrest.
  2. I am aware that this decision will not affect the provision of other emergency treatments, unless specified otherwise in additional advance directive documents.
  3. I understand that I can revoke this order at any time verbally or in writing to my healthcare provider.

Acknowledgment and Signature:

I hereby affirm that the information provided above is accurate and that I fully understand the implications of establishing a Do Not Resuscitate Order under the laws of the State of Ohio.

_________________________________ _____________________
Patient's Signature (or legally authorized representative) Date

_________________________________ _____________________
Witness Signature Date

_________________________________ _____________________
Healthcare Provider's Signature Date

This document should be kept by the patient and made readily available to healthcare providers. A copy should also be provided to the patient’s primary physician to be included in their medical records.

File Breakdown

Fact Name Description
Purpose The Ohio Do Not Resuscitate (DNR) Order is designed to inform medical professionals not to perform cardiopulmonary resuscitation (CPR) on the patient in the event their breathing or heart stops.
Applicability The form is applicable within the state of Ohio, guiding healthcare providers across various settings, including hospitals, nursing homes, and in-home care.
Governing Law The form and its processes are governed by the Ohio Revised Code (ORC), specifically sections related to health care directives and patient rights.
Who Can Sign The DNR order can be signed by the patient (if capable) or a legally authorized representative, such as a healthcare power of attorney, if the patient is unable.
Witness Requirement Ohio law requires the DNR order to be witnessed by an adult who is not the patient or the patient's healthcare agent.
Revocation The patient or their authorized representative can revoke the DNR order at any time, in any manner that indicates a desire to revoke, without requiring a specific form or procedure.

How to Use Ohio Do Not Resuscitate Order

Filling out an Ohio Do Not Resuscitate (DNR) Order form is a critical step for individuals who wish to make clear their preferences regarding life-sustaining treatments in emergencies. This document enables healthcare providers to know whether or not to perform resuscitation efforts in the event of cardiac or respiratory arrest. The process involves providing personal information, making specific medical decisions about resuscitation, and obtaining the required signatures. By accurately completing this form, individuals ensure their wishes are respected during crucial moments.

Steps to Fill Out the Ohio Do Not Resuscitate Order Form

  1. Start by entering the full legal name of the individual the DNR order is for. This ensures the document is accurately associated with the right person.
  2. Include the person's date of birth. This is another crucial piece of identification that helps healthcare providers verify the identity of the individual.
  3. Provide the person's complete address. This information is necessary for the DNR order to be properly indexed and stored in medical records.
  4. State the individual’s specific medical conditions if required. Some forms ask for this to give healthcare providers context about the person’s health status.
  5. Clearly mark the individual’s resuscitation preferences. The form typically offers options such as whether to attempt CPR or not. Make the choice that best represents the person’s wishes.
  6. Sign and date the form if you are the patient or have the legal authority to make healthcare decisions on the individual’s behalf. This formalizes the DNR order.
  7. Obtain the required healthcare provider’s signature. This might be a physician, nurse practitioner, or another qualified healthcare professional who agrees that the DNR order reflects the individual’s health status and wishes.
  8. If applicable, also get the signature of a witness. Some forms require this additional step to further validate the document.

After completing these steps, it's important to keep the DNR order in easily accessible places, such as with personal medical records or in a location known by family members. Additionally, discussing this decision with loved ones and healthcare providers ensures everyone is aware of the individual's wishes, providing peace of mind for all involved.

Crucial Questions on This Form

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

A Do Not Resuscitate (DNR) Order in Ohio is a legal document that tells health care providers not to perform CPR (cardiopulmonary resuscitation) if a person's breathing stops or if their heart stops beating. This order is used when an individual decides, due to personal or medical reasons, that they do not want attempts made to revive them in these situations. It is a specific part of advance directives in Ohio.

How can someone obtain a DNR Order in Ohio?

To obtain a DNR Order in Ohio, an individual must discuss their wishes with their healthcare provider. The decision to have a DNR Order should be made by the individual or their legal healthcare power of attorney if the individual is unable to make their own healthcare decisions. The healthcare provider will then fill out the DNR Order form, and it must be properly signed to be valid.

Who can sign the Ohio DNR Order?

The Ohio DNR Order can be signed by the individual for whom the DNR Order applies if they are competent and of legal age. If the individual is unable to make medical decisions for themselves due to physical or mental incapacity, a health care power of attorney, a legal guardian, or someone else legally authorized to make these decisions can sign the form on their behalf.

Is the DNR Order applicable in all settings?

In Ohio, the DNR Order is applicable in various settings including hospitals, nursing homes, and in the individual’s home. However, it's important for the individual or their family to communicate their DNR status to the healthcare providers in each new care setting. Each place may have their own procedures for documenting and recognizing DNR Orders.

Can the DNR Order be revoked?

Yes, the DNR Order can be revoked at any time by the individual for whom it applies. This can be done by destroying the DNR document, verbally expressing the wish to revoke it to a healthcare provider, or by any other act showing an intent to revoke the order. If someone else has authority over the individual's healthcare decisions, they can also revoke the DNR Order on the individual's behalf.

What happens if medical staff is not aware of the DNR Order?

If medical staff is not aware of an individual's DNR Order, they may proceed with CPR or other resuscitative measures in an emergency. It is crucial for individuals with a DNR Order, or their family members, to notify healthcare providers of the DNR status and perhaps wear a DNR identification bracelet or necklace. Having multiple copies of the DNR Order, in the home, with family members, and with the primary healthcare provider, can also help ensure it is respected.

Is a lawyer required to complete the DNR Order?

No, a lawyer is not required to complete the DNR Order in Ohio. However, consulting with a healthcare provider is necessary to ensure the form is filled out correctly according to Ohio law. If there are any legal questions or concerns about the DNR Order or its implications, consulting a lawyer who specializes in healthcare law might be beneficial.

Does a DNR Order affect other medical treatments?

No, a DNR Order does not affect the provision of other medical treatments. It specifically directs healthcare providers not to perform CPR. Individuals with a DNR Order will still receive any other medical treatments deemed necessary to provide comfort or to treat medical conditions, unless stated otherwise in an advance directive or similar legal document.

Common mistakes

  1. Not consulting with a medical professional or legal advisor before filling out the form. It is important to understand the implications of a Do Not Resuscitate (DNR) Order and how it aligns with one’s health care wishes and legal requirements in the state of Ohio.

  2. Incorrect or incomplete patient information. Providing accurate details such as the full legal name, date of birth, and patient identification number ensures the DNR Order is associated with the correct individual.

  3. Failing to have the DNR Order properly witnessed or signed. Ohio law requires that the form be signed by the appropriate parties, which may include the patient, a legal guardian, or a health care proxy. In some cases, a witness or notarization may be necessary.

  4. Skipping the date. The absence of a date can question the validity or the relevance of the DNR Order, as it indicates when the form was properly executed.

  5. Misunderstanding the scope of the DNR Order. Some people may not fully grasp that the order specifically applies to cardiopulmonary resuscitation (CPR) and does not affect other medical treatments or interventions.

  6. Not specifying the type of DNR Order. In Ohio, there are categories for DNR Orders such as DNR Comfort Care (DNR-CC) and DNR Comfort Care-Arrest (DNR-CC Arrest). Each has different implications for the care the patient wishes to receive in an emergency.

  7. Forgetting to distribute copies of the completed form. It's crucial to provide copies to family members, health care proxies, and medical providers to ensure that the patient’s wishes are understood and can be acted upon.

  8. Assuming the form is valid in other states. DNR Orders are state-specific. If a patient is traveling or relocates, they should check the laws in the new location and fill out the appropriate forms if necessary.

  9. Not reviewing and updating the DNR Order. A patient's preferences may change over time, or there may be changes in health condition or in state laws. Regular review and, if needed, updating of the DNR Order ensure that it reflects current wishes and complies with legal standards.

Documents used along the form

When preparing for end-of-life decisions in Ohio, the Do Not Resuscitate (DNR) Order form is an essential document, but it is often just one part of a comprehensive approach to advance care planning. Individuals and their families may also consider preparing additional forms and documents to ensure that their healthcare wishes are clearly communicated and legally documented. The following list includes some of the key documents often used alongside an Ohio DNR Order to provide a broader framework for healthcare decisions.

  • Advance Directive (Living Will) - This legal document outlines a person's wishes regarding medical treatment if they become unable to make decisions for themselves due to incapacity, specifically addressing conditions where death is imminent or the individual is in a permanent vegetative state.
  • Healthcare Power of Attorney - This document designates another person as the agent to make healthcare decisions on behalf of the individual if they are unable to do so. This includes decisions about implementing or not implementing resuscitation measures.
  • Last Will and Testament - Though not directly related to healthcare, the Last Will and Testament is crucial for specifying how a person’s assets and estate should be distributed after death. It can also appoint guardians for minor children.
  • Organ and Tissue Donation Form - This form enables individuals to document their wishes regarding organ and tissue donation at the time of death. It is a key part of end-of-life planning for many people.
  • Out-of-Hospital Do Not Resuscitate (OOH-DNR) Order - Similar to a DNR, this order is specifically for situations that occur outside of a hospital setting. It informs emergency medical personnel not to attempt resuscitation.
  • Medical Orders for Life-Sustaining Treatment (MOLST) - This form provides specific instructions about certain life-sustaining treatments based on the patient's current health condition. It is used in addition to a DNR to provide clear guidance to healthcare providers.
  • Physician Orders for Scope of Treatment (POST) - Similar to MOLST, this document is a physician order that outlines a plan of care respecting the patient’s wishes for treatment methods and intensity, including resuscitation.
  • Privacy Release Form (HIPAA Authorization) - This document allows healthcare providers to share or discuss an individual’s medical information with designated persons who are not legally authorized to make decisions on their behalf.

Each document plays a distinct role in a person's healthcare and estate planning, complementing the DNR Order by covering various scenarios and preferences. By thoughtfully preparing these documents, individuals can ensure their wishes are known and respected, providing peace of mind to themselves and their families. It is advisable to consult with legal professionals and healthcare providers when creating or updating these important documents to ensure they meet current legal standards and healthcare needs.

Similar forms

The Advanced Directive, also known as a living will, is similar to the Ohio Do Not Resuscitate (DNR) Order form in that it allows individuals to state their wishes regarding medical treatment in the event that they are unable to communicate those wishes themselves. Both documents are designed to guide healthcare providers on the type of care a patient desires, specifically in life-threatening situations or towards the end of life. While the DNR specifically addresses the wish not to have cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest, an advanced directive can cover a broader range of medical interventions.

A Health Care Power of Attorney (HCPOA) document, similar to the Ohio DNR, empowers individuals to make decisions about their medical care through an appointed agent, should they become incapacitated. Both documents serve to ensure that medical treatment aligns with the patient's desires. However, the HCPOA differs because it designates another person to make healthcare decisions on behalf of the patient for a range of decisions that are not limited to resuscitation.

The Medical Orders for Life-Sustaining Treatment (MOLST) form closely resembles the Ohio DNR in its function to delineate a patient’s preferences for medical interventions, including CPR. Unlike the broader scope of the DNR, the MOLST covers a wide spectrum of life-sustaining treatments, such as use of ventilators, feeding tubes, and antibiotics, and is intended for patients with serious health conditions. Both documents are used by healthcare providers to ensure the patient's healthcare preferences are respected.

The Physician Orders for Scope of Treatment (POST) is another document that shares similarities with the Ohio DNR. It is used primarily by individuals with serious illnesses or at the end of their life to detail their care preferences, including wishes about CPR. Like the DNR, the POST is a doctor's order and thus legally binding, ensuring that healthcare providers follow the patient's specified guidelines regarding emergency and life-sustaining treatments.

A Do Not Intubate (DNI) order is closely related to the Ohio DNR order in that it specifies a patient’s wish to avoid a specific life-saving intervention, in this case, intubation. While the DNR focuses on not receiving CPR, the DNI addresses the desire not to be placed on a mechanical ventilator. Both orders are used to communicate crucial decisions about end-of-life care preferences directly to medical professionals.

The Five Wishes document broadens the scope of personal healthcare directives by encompassing aspects covered by the DNR, such as the person’s wishes concerning medical treatment in serious situations, as well as addressing personal, emotional, and spiritual needs. It acts as a comprehensive care plan, offering a holistic approach to documenting one’s wishes regarding treatment preferences, comfort care, and other considerations beyond clinical interventions.

The Emergency Medical Services (EMS) No-CPR form is specifically designed for patients who wish emergency medical services personnel to withhold CPR in the event of cardiac or respiratory arrest, directly paralleling the purpose of the Ohio DNR. This form is crucial in emergency situations outside of a hospital setting. Although similar in purpose to the DNR, the EMS No-CPR form is often used in jurisdictions that require a separate document for pre-hospital settings.

Dos and Don'ts

Filling out the Ohio Do Not Resuscitate (DNR) Order form is a critical step in planning for medical care. It's essential to approach this process with care and understanding. To ensure your wishes are clearly communicated and legally recognized, consider the following dos and don'ts:

Do:
  1. Read the entire form carefully before you start filling it out.
  2. Consult with your healthcare provider to fully understand the implications of a DNR order.
  3. Use a black or blue pen to ensure the form is legible and photocopies well.
  4. Include all required personal information, accurately and without any abbreviations.
  5. Make sure to sign and date the form in the presence of a witness or notary, as required by Ohio law.
  6. Review the form with family members or loved ones to ensure your wishes are understood.
  7. Keep the original document in a readily accessible place and provide copies to your healthcare provider and family.
Don't:
  • Fill out the form in a hurry. Take your time to ensure all information is correct and reflects your wishes.
  • Use pencil or any ink color that is not easily photocopied, such as light blue or pink.
  • Leave any sections incomplete unless they are explicitly optional or do not apply to your situation.
  • Forget to update your DNR order if your health situation or wishes change.
  • Sign the form without the presence of the required witness or notary.
  • Assume that doctors and emergency responders will know about your DNR order without having a copy on hand.
  • Forget to discuss your DNR order with new healthcare providers if you change doctors or enter a new healthcare facility.

Misconceptions

Understanding the Do Not Resuscitate (DNR) Order form in Ohio is crucial for making informed healthcare decisions. However, there are several misconceptions about it that need to be clarified to ensure accurate comprehension of its use and implications.

  • Only the elderly or terminally ill can have a DNR Order. This is incorrect. Individuals of any age with serious health conditions or preferences regarding end-of-life care may opt for a DNR Order, subject to discussing it with their healthcare provider.

  • A DNR Order means all medical treatments will be stopped. This is not true. A DNR Order specifically addresses the cessation of cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. Other treatments related to comfort care and life-sustaining measures not involving CPR can still be provided based on the patient's wishes and healthcare provider's judgment.

  • A DNR Order is only valid in hospitals. This misconception could cause confusion about the applicability of a DNR Order. In Ohio, DNR Orders are not limited to hospitals; they can also be effective in other healthcare settings, at home, or in hospice care, provided they are properly documented and communicated to relevant healthcare professionals.

  • The family can override a patient's DNR Order. Legally, if a competent adult has established a DNR Order, family members cannot override it. Decisions regarding end-of-life care, including DNR Orders, rest with the patient or their legally authorized healthcare power of attorney, if the patient is unable to make decisions for themselves.

Clearing up these misconceptions is essential in respecting and implementing a patient's health care decisions accurately, ensuring that their wishes are upheld with dignity at critical moments.

Key takeaways

Filling out and using the Ohio Do Not Resuscitate (DNR) Order form requires careful consideration and adherence to specific steps. This document is critical for ensuring that a patient's wishes regarding resuscitation are respected in critical medical situations. Here are key takeaways to keep in mind when dealing with the Ohio DNR Order form:

  • The Ohio DNR Order form should only be filled out by or for individuals who wish to decline resuscitation efforts in the event they stop breathing or their heart stops beating. It's a personal choice that needs serious thought and, often, discussions with loved ones and healthcare providers.
  • It is essential to have a conversation with a healthcare provider before completing the DNR form. A healthcare provider can offer crucial insight into the medical implications of a DNR order and help to ensure that the form is filled out correctly.
  • The form must be completed and signed by the patient, or in certain cases, the patient's healthcare power of attorney or legal guardian. This is paramount to ensure the document is legally binding and respected by medical personnel.
  • Ensure that the form is easily accessible to emergency personnel. Once signed, it should be kept in an easily accessible location, and family members or caregivers should be made aware of where it is.
  • The Ohio DNR Order is specific to the state of Ohio. If you travel or live in multiple states, check the requirements and reciprocal recognition of DNR orders in those states as well.
  • Remember, the DNR Order can be revoked at any time by the patient or their authorized representative. The revocation process should be as straightforward as informing a healthcare provider or tearing up the form.
  • Photocopies or facsimiles of the signed DNR Order are generally considered as valid as the original. However, ensuring the legibility and availability of the form is crucial.
  • Discussing your wishes regarding a DNR Order with family, close friends, and healthcare providers is important to ensure that everyone is aware of your preferences and can act according to your wishes in an emergency.

Ultimately, the Ohio Do Not Resuscitate Order form is a legal document that reflects a fundamental choice about end-of-life care. It's about taking control of your healthcare decisions and ensuring that your wishes are known and respected. Whether you're considering completing a DNR order for yourself or are involved in the care of someone who is, it's important to approach the process with sensitivity, thoughtfulness, and the right information.

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