Official  Do Not Resuscitate Order Form for Indiana Create Your Do Not Resuscitate Order

Official Do Not Resuscitate Order Form for Indiana

A Do Not Resuscitate (DNR) Order form in Indiana is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form ensures that medical personnel understand a patient’s desire to forgo life-saving measures. For those considering this important decision, filling out the form is a crucial step; please click the button below to proceed.

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Documents used along the form

When considering end-of-life care options, it’s important to be aware of various forms and documents that complement the Indiana Do Not Resuscitate (DNR) Order. Each of these documents serves a specific purpose in ensuring that an individual's healthcare preferences are respected. Below are some key forms often used alongside a DNR order.

  • Living Will: This document outlines an individual's wishes regarding medical treatment in situations where they are unable to communicate their preferences. It typically addresses issues such as life-sustaining treatments and end-of-life care.
  • Healthcare Power of Attorney: This legal document allows a person to designate someone else to make healthcare decisions on their behalf if they become incapacitated. The appointed individual can ensure that the patient’s wishes, including those stated in a DNR, are followed.
  • Physician Orders for Life-Sustaining Treatment (POLST): This form is designed for individuals with serious illnesses or those who are nearing the end of life. It translates the patient’s preferences into actionable medical orders, which healthcare providers must follow.
  • Power of Attorney: A https://arizonapdfforms.com/power-of-attorney/ form is critical for empowering a designated person to handle financial or legal matters on your behalf, especially when you are unable to do so yourself.
  • Advance Directive: This is a broader term that encompasses both living wills and healthcare powers of attorney. It allows individuals to specify their healthcare preferences and appoint someone to make decisions if they cannot do so themselves.

Understanding these documents can empower individuals and their families to make informed decisions about medical care. It’s essential to have these forms in place to ensure that everyone is on the same page regarding healthcare preferences and to provide peace of mind during difficult times.

Common mistakes

  1. Not understanding the purpose of the form: Many individuals fill out the Indiana Do Not Resuscitate Order form without fully grasping what it entails. This can lead to unintended consequences regarding medical care.

  2. Inadequate communication with healthcare providers: Failing to discuss the decision with doctors or healthcare professionals can result in confusion about the patient’s wishes. Clear communication is crucial.

  3. Missing required signatures: The form must be properly signed by the patient or their legal representative. Omitting signatures can invalidate the order.

  4. Not updating the form: Life circumstances change. People often forget to update their Do Not Resuscitate Order after significant health changes or shifts in personal beliefs.

  5. Failing to provide copies: After completing the form, individuals sometimes neglect to give copies to family members or healthcare providers. This can lead to situations where the order is not honored.

  6. Using outdated forms: The Indiana Do Not Resuscitate Order form may be updated over time. Relying on an old version can cause complications when it comes to enforcement.

  7. Not discussing the decision with family: It’s important for individuals to talk about their choices with loved ones. Without these discussions, family members may be unaware of the patient’s wishes.

  8. Confusing the Do Not Resuscitate Order with other advance directives: Some people mistakenly believe that a Do Not Resuscitate Order is the same as a living will or power of attorney, leading to misinterpretations of their intentions.

  9. Ignoring state-specific requirements: Each state has unique laws governing Do Not Resuscitate Orders. Not adhering to Indiana’s specific requirements can render the form ineffective.

Key takeaways

When considering the Indiana Do Not Resuscitate Order (DNR) form, it's essential to understand its purpose and how to properly fill it out. Here are some key takeaways to keep in mind:

  1. Understand the Purpose: The DNR order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if your heart stops or you stop breathing.
  2. Eligibility: Any adult can complete a DNR order. It’s particularly relevant for individuals with serious health conditions or those who wish to avoid aggressive medical interventions.
  3. Consult with Healthcare Providers: Before filling out the form, discuss your wishes with your doctor or healthcare team. They can provide guidance tailored to your health situation.
  4. Complete the Form Accurately: Fill out all required sections clearly. This includes providing your name, date of birth, and signature, along with the date of the order.
  5. Witness Requirements: The DNR order must be signed by at least one witness who is not a relative or a healthcare provider involved in your care.
  6. Keep Copies Accessible: After completing the form, make several copies. Keep one at home, give one to your healthcare provider, and consider providing one to family members.
  7. Review Regularly: Your health status and preferences may change over time. Regularly review and update your DNR order as needed.
  8. Inform Loved Ones: Share your decision with family members or close friends. This ensures they understand your wishes and can advocate for you if necessary.
  9. Know the Legal Implications: A DNR order is legally binding in Indiana, meaning that healthcare providers must honor it. Be aware of how this impacts your care.

By keeping these points in mind, you can ensure that your DNR order reflects your wishes and provides clarity for your healthcare team and loved ones.

PDF Properties

Fact Name Description
Purpose The Indiana Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation in the event of a medical emergency.
Governing Law The DNR Order is governed by Indiana Code § 16-36-6, which outlines the legal framework for advance directives in the state.
Eligibility Any adult who is capable of making their own healthcare decisions can complete a DNR Order in Indiana.
Signature Requirements The form must be signed by the individual or their legal representative, and it should also be witnessed by two individuals or notarized.
Revocation Individuals can revoke a DNR Order at any time, and this can be done verbally or in writing.

More Indiana Templates

Form Example

Indiana Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is established in accordance with Indiana state laws concerning medical treatment preferences for individuals with terminal conditions or those who choose not to receive resuscitation in the event of cardiac or respiratory arrest.

Patient Information:

  • Full Name: ______________________________
  • Date of Birth: _________________________
  • Address: ________________________________
  • City: _________________________________
  • State: _____IN_____
  • ZIP Code: ____________

Healthcare Provider Information:

  • Provider Name: _________________________
  • Provider Contact Number: ______________

Patient's Directive:

The patient hereby directs that resuscitative measures not be initiated in the event of a cardiac or respiratory arrest. This includes, but is not limited to, the following treatments:

  • Cardiopulmonary resuscitation (CPR)
  • Advanced cardiac life support (ACLS)
  • Intubation and mechanical ventilation

This order is applicable in all settings, including but not limited to hospitals, nursing homes, and private residences.

Signature of Patient: _______________________

Date: ____________________________

Signature of Witness: _______________________

Date: ____________________________