Printable Do Not Resuscitate Order Form for Louisiana
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In Louisiana, the Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals who wish to express their preferences regarding medical treatment in emergencies. This form is designed to communicate a person's desire not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures in the event of cardiac arrest or respiratory failure. It is important for patients, families, and healthcare providers to understand the implications of a DNR order, as it ensures that medical interventions align with the individual's wishes. The form requires specific information, including the patient's name, date of birth, and a signature, which must be completed by a physician. Additionally, a DNR order can be revoked at any time, providing flexibility for individuals as their circumstances or preferences change. Understanding the DNR process and its significance can help alleviate confusion during critical moments, allowing for a respectful and compassionate approach to end-of-life care.
Louisiana Do Not Resuscitate Order Example
Louisiana Do Not Resuscitate Order
This Do Not Resuscitate (DNR) Order is created in accordance with Louisiana state laws governing advance directives. It specifies the wishes of the individual regarding resuscitation efforts in case of a medical emergency.
Patient Information:
- Name: ______________________________________
- Date of Birth: _____________________________
- Address: __________________________________
- City, State, Zip Code: _____________________
Healthcare Proxy (if applicable):
- Name: ______________________________________
- Contact Number: __________________________
- Relationship to Patient: ___________________
Order Statement:
I, the undersigned, hereby declare that I do not wish to receive cardiopulmonary resuscitation (CPR) or any other life-sustaining treatment as detailed below:
- In the event of cardiac arrest.
- In the event of respiratory failure.
- In any other situation where resuscitation would typically be performed.
Signature of Patient: ______________________________________
Date: ______________________________________
Witness Information:
- Name: ______________________________________
- Signature: ______________________________________
- Date: ______________________________________
This document must be kept in a visible location and presented to healthcare providers upon seeking medical assistance. The patient’s wishes should always be respected concerning any medical interventions.
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Documents used along the form
When preparing a Do Not Resuscitate (DNR) Order in Louisiana, several other documents may be useful. These forms can help ensure that your healthcare wishes are clearly communicated and respected. Below is a list of commonly used forms that often accompany a DNR Order.
- Advance Directive: This document outlines your preferences for medical treatment if you become unable to communicate. It can include specific wishes about life-sustaining treatments.
- Living Will: A living will specifies the types of medical treatments you want or do not want at the end of life. It helps guide healthcare providers in making decisions aligned with your values.
- Healthcare Power of Attorney: This form designates someone to make healthcare decisions on your behalf if you cannot do so. This person should understand your wishes and values.
- Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that details your preferences for treatments in emergency situations. It is intended for individuals with serious health conditions.
- Patient Information Form: This form collects essential information about your medical history, allergies, and medications. It helps healthcare providers deliver appropriate care.
- Power of Attorney Form: To ensure your wishes regarding financial matters are honored, consider utilizing the comprehensive Power of Attorney form guide for effective legal documentation.
- Do Not Hospitalize Order: This document indicates that you do not wish to be admitted to a hospital for treatment. It can be particularly relevant for individuals in hospice or palliative care.
- Medical Release Form: This form allows healthcare providers to share your medical information with designated individuals. It ensures that your loved ones are informed about your health status.
- Emergency Medical Services (EMS) Protocol: This protocol guides EMS personnel on how to respond to your wishes in emergency situations, particularly regarding resuscitation and treatment.
- Do Not Intubate Order: This document specifies that you do not want to be intubated if you cannot breathe on your own. It complements a DNR Order by addressing specific interventions.
Having these documents in place can provide peace of mind and clarity for both you and your loved ones. Make sure to discuss your wishes with your family and healthcare providers to ensure everyone is on the same page.
Key takeaways
Understanding the Louisiana Do Not Resuscitate (DNR) Order form is crucial for individuals who wish to express their healthcare preferences in a clear and legally recognized manner. Here are some key takeaways to consider:
- The DNR Order allows individuals to refuse cardiopulmonary resuscitation (CPR) in the event of a cardiac arrest.
- To complete the form, you must be at least 18 years old and capable of making your own healthcare decisions.
- It’s important to have the form signed by a licensed physician to ensure its validity.
- Once completed, the DNR Order should be kept in an easily accessible location, such as on the refrigerator or with other important medical documents.
- Communicate your wishes with family members and healthcare providers to avoid confusion during emergencies.
- The DNR Order can be revoked at any time, and it’s advisable to inform your physician and family if you choose to do so.
- Healthcare providers are legally obligated to honor a valid DNR Order, provided it is properly executed.
Being informed about the DNR process ensures that your healthcare preferences are respected when it matters most.