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Preview - Ohio Do Not Resuscitate Order Form
Ohio Do Not Resuscitate Order
This Do Not Resuscitate (DNR) Order is created in accordance with Ohio state law. It allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency.
Patient Information:
- Full Name: ________________________________________
- Date of Birth: _________________________________
- Address: _______________________________________
- City, State, Zip: _______________________________
Attending Physician Information:
- Physician's Name: __________________________________
- Medical License Number: _________________________
- Clinic/Hospital Name: ____________________________
- Address: _______________________________________
Patient's Decision:
I, ______________________________________, as the patient, express my wish that I do not wish to receive cardiopulmonary resuscitation (CPR) in the event my heart stops or I stop breathing. This choice may be made freely and voluntarily.
Signature: _______________________________________
Date: __________________________________________
Witness Information:
(Signature of Witness is required for the DNR to be valid)
- Witness Name: ______________________________________
- Address: _________________________________________
- Signature: ______________________________________
This order will be honored by all medical personnel, including hospitals, EMS, and other health care providers. Please keep this document accessible.
For further information regarding the laws governing DNR Orders in Ohio, please consult the Ohio Revised Code.
File Information
| Fact Name | Description |
|---|---|
| Definition | The Ohio Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a person's heart stops or they stop breathing. |
| Governing Law | The DNR Order in Ohio is governed by Ohio Revised Code Section 2133.21 through 2133.27. |
| Eligibility | Any adult who is capable of making their own healthcare decisions can complete a DNR Order. This includes individuals with terminal illnesses or those who wish to avoid aggressive medical interventions. |
| Form Requirements | The DNR Order must be signed by the patient or their legal representative and a physician. It should also include the date it was signed. |
| Distribution | Once completed, the DNR Order should be distributed to all healthcare providers involved in the patient's care. It is also advisable to keep a copy at home. |
| Revocation | The DNR Order can be revoked at any time by the patient or their legal representative. This can be done verbally or by destroying the document. |
| Emergency Medical Services (EMS) Compliance | EMS personnel are required to honor a valid DNR Order. They will check for the document before initiating resuscitation efforts. |
| Not a Living Will | A DNR Order is not the same as a living will. While a living will outlines general healthcare preferences, a DNR specifically addresses resuscitation efforts. |
Documents used along the form
The Ohio Do Not Resuscitate (DNR) Order form is a critical document for individuals who wish to specify their preferences regarding resuscitation efforts in the event of a medical emergency. However, it is often accompanied by other important forms and documents that help ensure a person's healthcare wishes are honored. Below is a list of these related documents, each serving a unique purpose in the realm of healthcare planning.
- Living Will: This document outlines an individual's preferences for medical treatment in situations where they are unable to communicate their wishes. It typically covers scenarios such as terminal illness or irreversible coma.
- Healthcare Power of Attorney: This form designates a trusted individual to make healthcare decisions on behalf of the person if they become incapacitated. It empowers the agent to act in accordance with the individual's wishes as expressed in the living will.
- Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that translates a patient’s preferences regarding life-sustaining treatments into actionable orders for healthcare providers. It is intended for individuals with serious illnesses or frailty.
- Do Not Intubate (DNI) Order: This order specifies that a patient should not be intubated, meaning they do not want to have a tube inserted to assist with breathing in the event of respiratory failure.
- Advance Directive: An advance directive is a broader term that encompasses both living wills and healthcare powers of attorney. It provides guidance on a person’s healthcare preferences and appoints someone to make decisions if needed.
- Organ Donation Consent Form: This document allows individuals to express their wishes regarding organ donation after death. It ensures that healthcare providers respect these wishes during end-of-life care.
- Patient Information Form: This form collects essential details about the patient, including medical history, allergies, and current medications. It aids healthcare providers in making informed decisions about treatment.
- Medical History Form: A comprehensive record of a patient's past medical conditions, surgeries, and treatments. This information is crucial for healthcare providers to understand the patient's overall health status.
- Emergency Contact Form: This document lists individuals to be contacted in case of a medical emergency. It ensures that loved ones are informed and involved in decision-making if necessary.
Each of these documents plays a vital role in healthcare planning and decision-making. Together, they help ensure that individuals’ wishes are clearly communicated and respected, providing peace of mind for both patients and their families.
Guidelines on Filling in Ohio Do Not Resuscitate Order
Filling out the Ohio Do Not Resuscitate Order form is a straightforward process. It’s important to ensure that all information is accurate and complete. Once the form is filled out, it can be presented to healthcare providers to communicate your wishes regarding resuscitation.
- Obtain the Ohio Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
- Read the instructions carefully to understand what information is required.
- Fill in your personal information, including your full name, date of birth, and address.
- Provide the name and contact information of your healthcare representative, if you have one.
- Clearly indicate your wishes regarding resuscitation by checking the appropriate box.
- Sign and date the form. Make sure to do this in the presence of a witness.
- Have a witness sign the form, confirming that they saw you sign it.
- Make copies of the completed form for your records and to share with your healthcare provider.
After completing the form, keep it in a safe place where it can be easily accessed. Share copies with your family and healthcare team to ensure everyone is aware of your wishes.
Common mistakes
When filling out the Ohio Do Not Resuscitate (DNR) Order form, many people make common mistakes that can lead to confusion or even legal issues. Understanding these pitfalls is essential for ensuring that your wishes are respected in a medical emergency.
One frequent mistake is not discussing the decision with family members or healthcare providers. Open conversations can clarify intentions and help everyone understand the reasons behind the choice. Without this dialogue, misunderstandings may arise during critical moments.
Another common error is failing to sign the form. A DNR Order must be signed by the patient or their authorized representative. If the signature is missing, healthcare professionals may not honor the order, potentially leading to unwanted resuscitation efforts.
Some individuals neglect to date the form. A DNR Order should include the date it was signed to ensure its validity. Without a date, it can be challenging to determine whether the order is current or outdated.
Additionally, people sometimes forget to provide specific instructions. The Ohio DNR Order form allows for customization. Clearly stating your wishes can prevent confusion and ensure that medical staff understand your preferences.
In some cases, individuals fail to keep copies of the DNR Order. It’s important to have multiple copies accessible to family members and healthcare providers. This way, everyone involved knows your wishes and can act accordingly.
Some people overlook the importance of updating the form as circumstances change. Life events, such as a new diagnosis or change in health status, may necessitate a revision of the DNR Order. Regularly reviewing and updating the document ensures it reflects your current wishes.
Another mistake is using outdated forms. Always check that you are using the most recent version of the Ohio DNR Order form. Using an old version may lead to complications or confusion about your intentions.
People also sometimes forget to include a witness signature if required. While not all DNR forms need a witness, some do. Check the specific requirements to ensure that your form is properly executed.
Finally, individuals may not fully understand the implications of a DNR Order. It’s crucial to comprehend what it means for your medical treatment. Consulting with a healthcare provider can help clarify any uncertainties and ensure that you make an informed decision.
By avoiding these common mistakes, individuals can ensure that their DNR Orders are valid and respected. Taking the time to fill out the form correctly can provide peace of mind for both the individual and their loved ones.
FAQ
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What is a Do Not Resuscitate (DNR) Order in Ohio?
A Do Not Resuscitate Order is a legal document that allows a person to refuse cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. In Ohio, this order is typically used by individuals with serious medical conditions who wish to avoid aggressive life-saving measures. It is important to have a clear understanding of your wishes and to communicate them with your healthcare provider.
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How can I obtain a DNR Order in Ohio?
To obtain a DNR Order in Ohio, you must first discuss your wishes with your physician. If you and your physician agree that a DNR is appropriate, they will complete the Ohio DNR Order form. This form must be signed by both you and your physician. Once completed, it should be kept in a prominent place, such as on your refrigerator or in your medical records, to ensure that emergency responders are aware of your wishes.
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Who can revoke a DNR Order in Ohio?
You have the right to revoke your DNR Order at any time. This can be done verbally or in writing. If you choose to revoke the order, inform your healthcare provider and ensure that any copies of the DNR are destroyed or marked as revoked. Additionally, family members or legally appointed representatives may also revoke the order on your behalf if you are unable to do so.
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Will a DNR Order affect my overall medical care?
A DNR Order specifically addresses resuscitation efforts in the event of cardiac or respiratory arrest. It does not affect other aspects of your medical care. You will continue to receive all other treatments and care as needed. It is essential to discuss your entire care plan with your healthcare provider to ensure that your wishes are understood and respected.