Free Do Not Resuscitate Order Form for the State of Pennsylvania

How to Fill Out Pennsylvania Do Not Resuscitate Order

Filling out the Pennsylvania Do Not Resuscitate Order form is an important step for individuals who wish to communicate their healthcare preferences clearly. Following these steps will help ensure that your wishes are documented properly.

1. Obtain the Pennsylvania Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
2. Fill in your full name and date of birth at the top of the form.
3. Indicate whether you are completing the form as a patient or a healthcare representative.
4. Provide the name and contact information of your healthcare representative, if applicable.
5. Review the section that outlines your wishes regarding resuscitation. Make sure to check the appropriate box to indicate your preference.
6. Sign and date the form. Ensure that your signature is clear and matches your name as printed on the form.
7. Have your physician sign the form. Their signature is necessary to validate the order.
8. Make copies of the completed form for your records and for your healthcare provider.
9. Share the form with family members and caregivers to ensure they are aware of your wishes.

Once you have completed the form, keep it in a safe but accessible location. It is essential that your healthcare team has a copy readily available in case of an emergency.

• Misconception 1: A Do Not Resuscitate (DNR) order means no medical care at all.

This is incorrect. A DNR order specifically pertains to resuscitation efforts in the event of cardiac or respiratory arrest. Other medical treatments and care can still be provided as needed.

• Misconception 2: Only terminally ill patients can have a DNR order.

This is not true. While many people with terminal illnesses choose to have a DNR, anyone can request one if they wish to avoid resuscitation in certain situations, regardless of their health status.

• Misconception 3: A DNR order is permanent and cannot be changed.

A DNR order can be revoked or modified at any time by the patient or their legal representative. It is important to communicate any changes to healthcare providers.

• Misconception 4: A DNR order only applies in hospitals.

This misconception overlooks the fact that a DNR order is valid across various healthcare settings, including at home, nursing facilities, and during emergency medical services.

• Misconception 5: A DNR order is the same as a living will.

These documents serve different purposes. A living will outlines a person's preferences for medical treatment in situations where they cannot communicate, while a DNR specifically addresses resuscitation efforts.

• Misconception 6: A DNR order is only for elderly individuals.

This is a common misunderstanding. People of any age can have a DNR order if they choose to decline resuscitation in certain circumstances.

• Misconception 7: Healthcare providers will not follow a DNR order.

Healthcare providers are legally obligated to respect a valid DNR order. It is crucial for the order to be properly documented and communicated to ensure compliance.

• Misconception 8: A DNR order is only for patients who are unconscious.

A DNR order can be established by individuals who are fully conscious and capable of making their own medical decisions. It reflects their wishes regarding resuscitation efforts.

When filling out and using the Pennsylvania Do Not Resuscitate Order form, it’s important to understand the following key points:

1. Eligibility: Only a licensed physician can complete the Do Not Resuscitate Order. Ensure that the order is signed by a doctor who understands your medical situation.
2. Patient Consent: The patient must be informed and consent to the order. This ensures that their wishes are respected and understood.
3. Clear Communication: Share copies of the completed form with family members and caregivers. Clear communication helps everyone understand the patient’s wishes.
4. Display the Form: Keep the Do Not Resuscitate Order visible. It should be placed in a location where emergency personnel can easily find it, such as on the refrigerator or in a medical file.
5. Regular Review: Review the order regularly. Life circumstances and medical conditions can change, and it’s important to ensure the order still reflects the patient’s wishes.

Completing the Pennsylvania Do Not Resuscitate (DNR) Order form is an important step for individuals wishing to express their preferences regarding resuscitation efforts in case of a medical emergency. However, several common mistakes can occur during this process, which may lead to confusion or unintended consequences.

One frequent mistake is not providing clear identification. Individuals must ensure that their full name, date of birth, and other identifying information are accurately filled out. Missing or incorrect details can complicate the enforcement of the DNR order, especially in emergency situations.

Another common error involves the lack of a signature. It is essential that the individual completing the form signs it. Without a signature, the document may be considered invalid. Additionally, witnesses may also need to sign, depending on the specific requirements, which should not be overlooked.

People often fail to communicate their wishes to family members or healthcare providers. A DNR order is only effective if those involved in the individual's care are aware of it. Discussing the order with loved ones and healthcare professionals ensures that everyone understands the individual's preferences and can act accordingly.

Some individuals may also neglect to review the form for completeness. Each section of the DNR order should be thoroughly checked to ensure that all necessary information is included. Leaving sections blank or providing vague responses can lead to misunderstandings about the individual's wishes.

Lastly, individuals sometimes do not keep their DNR order accessible. It is crucial to store the completed form in a place where it can be easily found, such as with medical records or in a visible location at home. If emergency personnel cannot locate the document quickly, the individual's wishes may not be honored.