Blank Do Not Resuscitate Order Document for Illinois State Open Editor

Blank Do Not Resuscitate Order Document for Illinois State

The Illinois Do Not Resuscitate Order form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. By completing this form, a person can ensure that healthcare providers respect their decision not to receive life-saving measures. Understanding this form is crucial for anyone considering their end-of-life care options.

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What to Know About This Form

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

    A Do Not Resuscitate Order is a medical order that indicates a person's wishes not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures in the event of cardiac or respiratory arrest. In Illinois, this order must be documented on a specific form that is recognized by healthcare providers.

  2. Who can request a DNR Order?

    In Illinois, a DNR Order can be requested by an adult patient who is capable of making their own medical decisions. If the patient is unable to make decisions, a legally authorized representative, such as a spouse, adult child, or parent, can request the order on their behalf.

  3. How do I obtain a DNR Order form?

    You can obtain a DNR Order form from various sources. Hospitals, healthcare providers, and certain online resources provide the form. It's important to ensure that you are using the official Illinois DNR Order form to ensure it is valid.

  4. What information is needed to complete the DNR Order form?

    The DNR Order form requires basic information about the patient, including their name, date of birth, and medical history. Additionally, the form must be signed by the patient or their authorized representative, as well as a physician who agrees with the decision.

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

    Yes, a properly completed DNR Order is valid in all healthcare settings in Illinois, including hospitals, nursing homes, and at home. It is crucial to ensure that the form is readily available and easily accessible to healthcare providers when needed.

  6. Can a DNR Order be revoked?

    Yes, a DNR Order can be revoked at any time. The patient or their authorized representative can communicate their wish to revoke the order verbally or in writing. It is important to notify healthcare providers of any changes to ensure that the patient's current wishes are respected.

  7. What should I do after completing the DNR Order form?

    Once the DNR Order form is completed and signed, make several copies. Keep one copy in a visible location at home, and provide copies to your healthcare provider and any family members involved in your care. This ensures that everyone is aware of your wishes.

Misconceptions

Understanding the Illinois Do Not Resuscitate (DNR) Order form is crucial for making informed healthcare decisions. Here are some common misconceptions about this important document:

  • A DNR order means that no medical care will be provided. This is not true. A DNR order specifically addresses resuscitation efforts, such as CPR. Other medical treatments and care will still be provided.
  • Only terminally ill patients need a DNR order. Anyone can request a DNR order, regardless of their health status. It is a personal choice based on individual values and preferences.
  • A DNR order is permanent and cannot be changed. DNR orders can be revoked or modified at any time. Individuals have the right to change their decisions as their circumstances or wishes evolve.
  • Healthcare providers will ignore a DNR order if they believe it is not in the patient's best interest. Healthcare providers are legally obligated to honor a valid DNR order. It is essential for patients to communicate their wishes clearly.
  • You must have a lawyer to complete a DNR order. While legal advice can be helpful, it is not necessary to have a lawyer to fill out a DNR order. The form is designed to be straightforward and accessible.
  • A DNR order is only valid in hospitals. A DNR order is valid in any healthcare setting, including at home or in long-term care facilities, as long as it is properly completed.
  • Signing a DNR order means giving up on life. This misconception overlooks the fact that a DNR order reflects a person's wishes regarding end-of-life care. It can be a thoughtful decision about how one wants to approach their health care.
  • DNR orders are only for older adults. People of all ages can have a DNR order. It is a personal decision based on individual values, not solely age.
  • A DNR order is a “do not treat” order. A DNR order specifically addresses resuscitation efforts. Other treatments and care will continue as needed, based on the patient's condition and preferences.

It is vital to have open discussions with loved ones and healthcare providers about DNR orders. Understanding the facts can help ensure that personal healthcare choices are respected.

PDF Form Attributes

Fact Name Description
Purpose The Illinois Do Not Resuscitate Order (DNR) form allows individuals to refuse resuscitation in the event of cardiac arrest or respiratory failure.
Governing Law This form is governed by the Illinois DNR law, specifically 410 ILCS 605/1 et seq.
Eligibility Any adult can complete a DNR order, but it must be signed by a physician and the patient or their legal representative.
Validity The DNR order remains valid across healthcare settings in Illinois as long as it is properly completed and signed.

Common mistakes

  1. Not providing the patient's full legal name. It's important to include the complete name to avoid any confusion.

  2. Failing to include the date of birth. This detail helps to confirm the identity of the patient.

  3. Not signing the form. A signature is necessary to make the order valid.

  4. Forgetting to have a witness sign. A witness is needed to verify that the patient understands the order.

  5. Leaving out the patient's signature. The patient must agree to the order for it to be effective.

  6. Using outdated forms. Always ensure you have the most current version of the Do Not Resuscitate Order form.

  7. Not discussing the order with healthcare providers. Communication is key to ensure everyone is on the same page.

  8. Overlooking the need for a copy in multiple locations. Keep copies at home, with healthcare providers, and in medical records.

  9. Failing to review the order regularly. Life circumstances can change, and the order may need to be updated.

Preview - Illinois Do Not Resuscitate Order Form

Illinois Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order is based on the Illinois Department of Public Health guidelines and should be completed by an individual who is at least 18 years old or an authorized representative.

Patient Information

  • Patient's Full Name: ________________________________
  • Patient's Date of Birth: ________________________________
  • Patient's Address: ________________________________

Physician Information

  • Physician's Name: ________________________________
  • Physician's Contact Number: ________________________________

Patient's Wishes

I, the undersigned, wish to refuse resuscitation attempts in the event of a cardiac or respiratory arrest. I understand that this decision may result in my death.

Signature of Patient or Authorized Representative

  • Signature: ________________________________
  • Date: ________________________________

Witness Statement

I declare that I am at least 18 years of age and that I witnessed the signing of this Do Not Resuscitate Order.

  • Witness's Name: ________________________________
  • Witness's Signature: ________________________________
  • Date: ________________________________

This Do Not Resuscitate Order is valid only when properly completed and signed. For any questions regarding this document, please consult a healthcare professional or legal advisor.

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