Homepage Attorney-Approved Do Not Resuscitate Order Template Attorney-Approved Do Not Resuscitate Order Document for the State of Indiana
Outline

In the realm of healthcare, the Indiana Do Not Resuscitate (DNR) Order form serves as a vital tool for individuals wishing to communicate their preferences regarding life-sustaining treatments. This form empowers patients to make informed decisions about their end-of-life care, ensuring that their wishes are respected in critical moments. By completing the DNR Order, individuals indicate that they do not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. The form must be signed by a qualified healthcare provider and can be presented in various healthcare settings, from hospitals to home care environments. Importantly, the DNR Order is not a standalone document; it is part of a broader conversation about advance care planning, which includes discussions about the patient’s values, goals, and overall healthcare preferences. In Indiana, the DNR Order is recognized as a legally binding directive, providing peace of mind to patients and their families during some of life’s most challenging moments. Understanding the nuances of this form can help individuals navigate the complexities of medical care and ensure that their choices are honored with dignity and respect.

Sample - Indiana Do Not Resuscitate Order Form

Indiana Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is a legally recognized document in the state of Indiana. It allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This document is governed by Indiana Code Title 16, Article 36, Chapter 6.5.

Please fill in the following information:

  • Patient's Full Name: ___________________________
  • Date of Birth: _______________________________
  • Address: ____________________________________
  • City, State, Zip Code: ______________________
  • Phone Number: _____________________________
  • Healthcare Provider's Name: ________________
  • Healthcare Provider's Phone Number: __________

By signing this document, I, the undersigned, declare that I do not wish to receive cardiopulmonary resuscitation (CPR) or other life-saving measures in the event of cardiac arrest or respiratory failure. I understand that this order will be honored by medical personnel and healthcare providers.

Signature of Patient: ___________________________

Date: ______________________________________

If the patient is unable to sign, a legal representative may sign on their behalf. Please provide the following information:

  • Legal Representative's Full Name: _______________
  • Relationship to Patient: _______________________
  • Signature of Legal Representative: ______________
  • Date: ______________________________________

This DNR Order should be kept in a place where it can be easily accessed by healthcare providers. It is advisable to share copies of this document with family members and your healthcare team.

For further information regarding the legal aspects of this order, please consult with a healthcare professional or legal advisor.

File Characteristics

Fact Name Description
Governing Law The Indiana Do Not Resuscitate Order form is governed by Indiana Code Title 16, Article 36, Chapter 6.
Eligibility Any adult may complete a Do Not Resuscitate Order, provided they have the capacity to make healthcare decisions.
Signature Requirement The form must be signed by the patient or their authorized representative, along with a physician's signature to be valid.
Form Accessibility The Indiana Do Not Resuscitate Order form is available online and can be printed for use in healthcare settings.

Detailed Guide for Filling Out Indiana Do Not Resuscitate Order

Filling out the Indiana Do Not Resuscitate Order form is a crucial step in ensuring that your healthcare preferences are honored. Once completed, this form will need to be shared with your healthcare providers and kept in an easily accessible location. Follow the steps below to fill out the form accurately.

  1. Obtain the Indiana Do Not Resuscitate Order form from a reliable source, such as a healthcare provider or the Indiana State Department of Health website.
  2. Begin by entering your full name at the top of the form.
  3. Provide your date of birth in the designated section.
  4. Fill in your address, including street, city, state, and zip code.
  5. Designate a healthcare representative if you wish. Include their name and contact information.
  6. Indicate your wishes regarding resuscitation by checking the appropriate box on the form.
  7. Sign and date the form at the bottom. Ensure that your signature is clear.
  8. Have a witness sign the form. The witness should also print their name and date the signature.
  9. Make copies of the completed form for your records and for your healthcare providers.

After completing these steps, ensure that the form is stored safely and that those involved in your care are aware of its existence. This will help to ensure your wishes are respected in any medical situation.

Obtain Answers on Indiana Do Not Resuscitate Order

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

    A Do Not Resuscitate Order is a legal document that allows a person to refuse cardiopulmonary resuscitation (CPR) and other life-saving measures in the event of cardiac arrest or respiratory failure. In Indiana, this order is recognized by healthcare providers and is intended to honor the wishes of individuals who do not wish to undergo resuscitation efforts.

  2. Who can request a DNR Order in Indiana?

    In Indiana, a DNR Order can be requested by a competent adult or by a legal representative, such as a guardian or healthcare proxy, on behalf of an incapacitated person. It is important that the individual requesting the order understands the implications and that the decision reflects the patient's wishes.

  3. How do I obtain a DNR Order form in Indiana?

    You can obtain a DNR Order form from various sources, including:

    • Your healthcare provider or physician's office
    • Hospitals and medical facilities
    • Indiana's state health department website

    Once you have the form, fill it out completely and ensure it is signed by both the patient and a physician to make it valid.

  4. What should I do after completing the DNR Order?

    After completing the DNR Order, it is crucial to share copies with your healthcare provider, family members, and anyone involved in your care. Keep a copy in a visible location, such as on your refrigerator or in a medical file, so that emergency responders can easily access it if needed.

  5. Can a DNR Order be revoked or changed?

    Yes, a DNR Order can be revoked at any time. If you decide to change your mind, simply notify your healthcare provider and destroy any copies of the existing DNR Order. It is advisable to create a new order if you wish to specify different wishes regarding resuscitation.

Common mistakes

When filling out the Indiana Do Not Resuscitate (DNR) Order form, individuals often encounter several common mistakes that can lead to confusion or complications. One prevalent error is failing to provide complete and accurate personal information. This includes the patient's name, date of birth, and contact details. Incomplete information can hinder the effectiveness of the DNR order, as medical personnel may struggle to verify the patient's identity in critical situations.

Another frequent mistake involves not having the form properly signed and witnessed. The Indiana DNR Order requires the signatures of both the patient and a witness. Without these signatures, the document may not be considered valid. It is essential to ensure that the witness is not a family member or someone who stands to benefit from the patient's estate, as this could raise questions about the authenticity of the form.

Additionally, individuals may overlook the importance of discussing their wishes with family members and healthcare providers. A DNR order is a significant decision that affects not only the patient but also their loved ones. Failing to communicate these wishes can lead to misunderstandings and emotional distress during critical moments. Open conversations about the DNR order can help ensure that everyone involved understands the patient's preferences.

Lastly, some people neglect to review and update their DNR orders regularly. Life circumstances change, and so do healthcare preferences. It is crucial to revisit the DNR order periodically to ensure it accurately reflects the patient's current wishes. A document that has not been updated may not align with the patient's current health status or desires, potentially leading to unwanted medical interventions.

Documents used along the form

When considering end-of-life care options, individuals and families may encounter various documents that complement the Indiana Do Not Resuscitate Order (DNR) form. Each of these forms serves a unique purpose in ensuring that a person's healthcare wishes are respected and clearly communicated. Below is a list of commonly used forms and documents associated with the DNR form.

  • Advance Directive: This document outlines a person's preferences for medical treatment in the event they are unable to communicate their wishes. It can include instructions on life-sustaining measures and appoint a healthcare proxy.
  • Living Will: A type of advance directive, a living will specifically details a person's wishes regarding medical treatments and interventions at the end of life, such as the use of ventilators or feeding tubes.
  • Healthcare Power of Attorney: This legal document allows an individual to designate someone else to make healthcare decisions on their behalf if they become incapacitated.
  • Physician Orders for Scope of Treatment (POST): This form translates a patient's preferences regarding treatment into actionable medical orders, guiding healthcare providers in emergency situations.
  • Do Not Intubate (DNI) Order: Similar to a DNR, this order specifically instructs healthcare providers not to insert a breathing tube if a patient is unable to breathe on their own.
  • Organ Donation Consent: This document expresses an individual's wishes regarding the donation of their organs and tissues after death, ensuring that their preferences are honored.
  • Patient Bill of Rights: This document outlines the rights of patients in a healthcare setting, including the right to make decisions about their care and to be informed about their treatment options.
  • Medical History Form: This form provides healthcare providers with essential information about a patient’s medical history, allergies, and current medications, which can be crucial in emergencies.

Understanding these documents can empower individuals and families to make informed decisions regarding healthcare preferences. It is essential to have open discussions with loved ones and healthcare providers to ensure that everyone is aware of and respects these important wishes.

Similar forms

A Do Not Resuscitate (DNR) Order is a specific document that outlines a person's wishes regarding resuscitation efforts in the event of cardiac or respiratory arrest. Several other documents share similarities with the DNR in terms of purpose and function. Here’s a list of ten documents that are comparable:

  • Living Will: This document allows individuals to express their preferences for medical treatment in situations where they cannot communicate their wishes. Like a DNR, it focuses on end-of-life decisions.
  • Healthcare Proxy: A healthcare proxy designates someone to make medical decisions on behalf of an individual if they become incapacitated. This can include decisions about resuscitation, similar to a DNR.
  • Advance Directive: An advance directive encompasses both a living will and a healthcare proxy. It provides a comprehensive plan for medical care preferences, including resuscitation wishes.
  • POLST (Physician Orders for Life-Sustaining Treatment): This medical order translates a patient’s treatment preferences into actionable physician orders. It can include instructions about resuscitation, much like a DNR.
  • Do Not Intubate (DNI) Order: A DNI order specifically indicates that a patient does not wish to be intubated. It is often used in conjunction with a DNR to clarify resuscitation preferences.
  • Patient Care Preferences: This document outlines an individual’s preferences for various aspects of care, including resuscitation. It serves as a guide for healthcare providers, similar to a DNR.
  • End-of-Life Care Plan: An end-of-life care plan details an individual's wishes regarding their care as they approach the end of life. It can address resuscitation decisions, aligning with the intent of a DNR.
  • Do Not Hospitalize (DNH) Order: A DNH order expresses a patient's wish to avoid hospitalization in certain situations. It can reflect similar values as a DNR, emphasizing comfort over aggressive treatment.
  • Medical Orders for Scope of Treatment (MOST): This document outlines a patient’s treatment preferences and can include directives about resuscitation, akin to a DNR.
  • Comfort Care Order: A comfort care order focuses on providing relief from pain and suffering rather than aggressive treatments. It aligns with the philosophy behind a DNR, prioritizing quality of life.

Dos and Don'ts

When filling out the Indiana Do Not Resuscitate Order form, it’s important to be careful and thorough. Here are some things to keep in mind:

  • Do ensure that the form is completed in full. Missing information can lead to confusion.
  • Don't sign the form without understanding its implications. Make sure you know what a DNR means.
  • Do have a conversation with your healthcare provider. They can help clarify any questions you may have.
  • Don't forget to keep a copy of the completed form. It’s essential to have it accessible for emergency situations.
  • Do review the form regularly. Your wishes may change over time, and it’s important to keep the document updated.

Misconceptions

Understanding the Indiana Do Not Resuscitate (DNR) Order form is essential for individuals and families facing critical health decisions. Unfortunately, several misconceptions can cloud judgment and lead to confusion. Here are five common misconceptions about the Indiana DNR Order form:

  1. A DNR order means no medical care will be provided.

    This is a significant misunderstanding. A DNR order specifically instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac arrest. However, it does not prevent other forms of medical treatment or care. Patients will still receive necessary medical attention, including pain management and comfort care.

  2. Only terminally ill patients can have a DNR order.

    This misconception suggests that DNR orders are only for those with a terminal illness. In reality, any individual can request a DNR order, regardless of their health status. The decision is deeply personal and can be based on individual values and preferences regarding end-of-life care.

  3. A DNR order is permanent and cannot be changed.

    Many believe that once a DNR order is established, it cannot be altered. This is not true. Individuals can change or revoke a DNR order at any time, as long as they are mentally competent to make that decision. It is essential to communicate any changes to medical personnel and family members.

  4. The DNR order is only valid in hospitals.

    Some people think that DNR orders are only applicable within hospital settings. In Indiana, a properly executed DNR order is valid in various settings, including homes and long-term care facilities. However, individuals should ensure that their wishes are communicated clearly to caregivers and emergency responders outside of a hospital.

  5. Having a DNR order means giving up on life.

    This belief can lead to emotional distress and hesitation in making the decision. A DNR order does not signify a desire to end life; rather, it reflects a person's choice to avoid aggressive resuscitation efforts in specific situations. It is about prioritizing quality of life and aligning medical interventions with personal values.

Clarifying these misconceptions can empower individuals and families to make informed decisions regarding their healthcare preferences. Open discussions about DNR orders and end-of-life care can lead to better understanding and respect for personal choices.

Key takeaways

When considering the Indiana Do Not Resuscitate (DNR) Order form, it is essential to understand its purpose and implications. Here are key takeaways to keep in mind:

  • The DNR Order allows individuals to refuse resuscitation efforts in the event of cardiac or respiratory arrest.
  • It must be signed by a physician and the patient or their authorized representative to be valid.
  • Patients can revoke the DNR Order at any time, ensuring their wishes can change as circumstances evolve.
  • It is important to communicate the existence of the DNR Order to all healthcare providers involved in the patient's care.
  • The form should be easily accessible, such as kept in a medical record or displayed prominently in the patient's home.