Attorney-Approved  Do Not Resuscitate Order Form for Arkansas Fill Out My Document

Attorney-Approved Do Not Resuscitate Order Form for Arkansas

The Arkansas Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to indicate their wish not to receive cardiopulmonary resuscitation (CPR) in the event their heart stops or they stop breathing. This form communicates an individual's decision regarding end-of-life care to healthcare professionals, ensuring that their wishes are respected. For those considering this decision, it's important to complete the form accurately; click the button below to start the process.

Fill Out My Document
Article Map

In the picturesque state of Arkansas, individuals who wish to have a say in their medical treatment during critical moments have the option to use the Do Not Resuscitate (DNR) Order Form. This important document acts as a directive for healthcare professionals, indicating the patient's preference not to undergo CPR (Cardiopulmonary Resuscitation) or other life-saving measures in the event their heart stops or they stop breathing. Tailored to respect the wishes of the patient, the form is grounded in the principle of personal autonomy and the right to decline medical interventions that extend life. Completing this form is a significant decision that requires thoughtful consideration and, often, discussions with loved ones and healthcare providers. It’s a legal tool designed to ensure that a person's medical treatment preferences are known and honored at a time when they might not be able to communicate their wishes. The Arkansas DNR Order Form is more than just a piece of paper; it's a declaration of one’s healthcare intentions, ensuring they are respected during the most vulnerable moments of life.

Preview - Arkansas Do Not Resuscitate Order Form

Arkansas Do Not Resuscitate (DNR) Order

This Do Not Resuscitate (DNR) Order is specific to the State of Arkansas. It is governed by the Arkansas Department of Health guidelines and the relevant Arkansas statutes. This document serves as a directive for medical professionals regarding the resuscitation preferences of the individual named herein, in accordance with Arkansas law.

Patient Information:

  • Full Name: ________________________________
  • Date of Birth: _____________________________
  • Address: __________________________________
  • City: _____________________________________
  • State: Arkansas
  • Zip Code: _________________________________

Medical Professional or Healthcare Representative Information (if applicable):

  • Full Name: ________________________________
  • Title: ____________________________________
  • Contact Number: ___________________________

In accordance with the relevant Arkansas statutes and regulations, the undersigned (or their legally authorized representative) hereby requests and consents to the Do Not Resuscitate (DNR) order as outlined in this document. This order indicates that in the event of cardiac or respiratory arrest, no resuscitative measures should be initiated by healthcare providers.

This decision is made after careful consideration of all relevant information and reflects the wishes of the individual or their duly authorized representative.

Signature Section:

  1. Patient’s Signature: ___________________________ Date: ______________
  2. Legal Representative’s Signature (if applicable): _____________________ Date: ______________
  3. Witness Signature: ____________________________ Date: ______________
  4. Physician’s Signature: _________________________ Date: ______________

By signing this document, all parties acknowledge and affirm that the individual's wishes regarding resuscitation have been clearly communicated and understood. This order will remain in effect until revoked or modified by the patient or their legal representative.

Notice: A copy of this Do Not Resuscitate (DNR) Order should be kept with the patient at all times. Additional copies should be filed with the patient’s primary care physician and included in the medical record.

Form Information

Fact Detail
Purpose The Arkansas Do Not Resuscitate (DNR) Order form is used to inform medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event the patient's breathing or heart stops.
Governing Law The form is governed by the laws of the State of Arkansas, specifically under the Health and Safety statutes that outline the use and requirements of DNR orders.
Who Can Authorize It can be authorized by the patient themselves if they are of sound mind and competent or by the patient's legally recognized health care proxy or guardian if the patient is unable to make medical decisions.
Form Validity The form is valid throughout the State of Arkansas and must be signed by both the patient (or authorized representative) and the physician.
Revocation A DNR order can be revoked at any time by the patient or their authorized representative through a written or oral declaration to the attending physician.

Steps to Writing Arkansas Do Not Resuscitate Order

A Do Not Resuscitate (DNR) order in Arkansas is a crucial document for those wishing to forgo life-sustaining treatments like CPR in the event of a cardiac or respiratory arrest. This document ensures that a patient's wishes regarding end-of-life care are respected by health care providers. Filling out this form requires careful attention to detail and an understanding of the individual's medical wishes. Following the right steps can ease the process for the patient, their family, and healthcare professionals. Here's how to properly complete the form:

  1. Gather necessary information including the patient's full legal name, date of birth, and medical conditions. This information should be accurate to avoid any confusion.
  2. The patient or their legally authorized representative (if the patient is unable to do so) must sign the form. This signature formally indicates the decision to not receive CPR or other life-sustaining treatments.
  3. The attending physician's signature is required. The physician must review the form for accuracy and ensure that the patient or the patient’s representative understands the implications of a DNR order.
  4. Include the date when the form is filled out and signed. This date is essential for healthcare providers to determine the form's validity.
  5. Make sure to discuss the DNR order with all healthcare providers involved in the patient's care to ensure they are aware of the patient’s wishes. This communication is crucial for the DNR order to be respected across different settings.
  6. Keep the original DNR order in an easily accessible location. In the case of an emergency, healthcare providers will need to see the original document quickly to comply with the patient's wishes.
  7. Copies of the DNR order should be given to the patient’s legal representative and family members who are likely to be present in an emergency situation. They can help communicate the patient's wishes to medical personnel if needed.

Completing the Arkansas Do Not Resuscitate Order form is a significant step in planning for one’s healthcare preferences towards the end of life. It ensures that the patient's decisions are respected and followed, minimizing undue stress on the patient, their loved ones, and healthcare providers in critical moments. The process requires careful consideration and clear communication among all parties involved. Ensuring the form is properly completed and accessible can provide peace of mind for everyone concerned.

Frequently Asked Questions

What is a Do Not Resuscitate Order (DNR) in Arkansas?

A Do Not Resuscitate Order (DNR) in Arkansas is a legal document that informs medical professionals not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating. It is used to respect the wishes of individuals who do not want lifesaving measures to be taken in these situations.

How can someone obtain a DNR order in Arkansas?

To obtain a DNR order in Arkansas, an individual must discuss their wishes with their healthcare provider. The healthcare provider, often a physician, will then need to agree that a DNR order is in the best interest of the patient's health and quality of life and will fill out the necessary paperwork.

Is patient consent required to issue a DNR order in Arkansas?

Yes, patient consent is generally required to issue a DNR order in Arkansas. The patient must clearly communicate their desire not to receive CPR in the event of a cardiac or respiratory arrest. If the patient is unable to provide consent due to incapacity, a legally authorized representative, such as a healthcare proxy or durable power of attorney for healthcare, may provide consent on the patient’s behalf.

Can a DNR order be revoked or cancelled?

Yes, a DNR order can be revoked or cancelled at any time by the patient or their legally authorized representative. To revoke the order, the patient or representative must inform the healthcare provider of their decision, and the provider will document the revocation in the patient's medical record.

Who should be informed about a patient’s DNR order?

It is important to inform family members and caregivers about a patient’s DNR order. Additionally, all healthcare providers involved in the patient’s care should also be made aware of the order to ensure it is respected and followed in the case of an emergency.

Does a DNR order affect other medical treatments?

No, a DNR order does not affect the provision of other medical treatments. It specifically instructs healthcare professionals not to initiate CPR in the event of cardiac or respiratory arrest. Patients with a DNR order will still receive all other appropriate medical treatments and interventions to provide comfort and to treat other medical conditions.

Is a DNR order valid across different healthcare settings?

In Arkansas, a DNR order is generally recognized across different healthcare settings, including hospitals, nursing homes, and in the home. However, it is advisable to have a copy of the DNR order readily available to present to healthcare providers in any new care setting.

How long does a DNR order remain valid in Arkansas?

A DNR order remains valid in Arkansas until it is revoked. There is no predetermined expiration date for a DNR order; however, it is a good practice to review the order periodically with healthcare providers, especially if there is a significant change in the patient's health condition.

What happens if a DNR order is not accessible during an emergency?

If a DNR order is not immediately accessible during an emergency, healthcare providers may proceed with CPR and other resuscitative efforts. It is critical for patients or their representatives to keep the DNR documentation readily accessible and to inform healthcare providers of its existence to ensure the patient's wishes are honored.

Common mistakes

When filling out the Arkansas Do Not Resuscitate (DNR) Order form, individuals often overlook important details. To ensure clear communication regarding their health care decisions, attention to common mistakes can prevent future complications. Below is a list of ten common errors:

  1. Not including the full legal name, which can lead to confusion with patients who have similar names.
  2. Omitting the date of birth, a critical piece of information to verify the patient's identity.
  3. Failing to provide accurate contact information for a legal representative or next of kin, which can impede necessary communication.
  4. Signing without the presence of a witness or notary, where required, which could invalidate the form.
  5. Overlooking the need for a physician’s signature, a crucial step for the DNR order to be legally binding.
  6. Not specifying the conditions under which the DNR order applies, leading to potential misunderstandings in emergency situations.
  7. Using an outdated form that may not comply with current state laws and regulations.
  8. Not discussing the decision with family or close friends, which may result in conflicts or confusion at critical moments.
  9. Forgetting to make copies of the signed form available to family members and healthcare providers.
  10. Assuming the DNR order is applicable in all settings without verifying state-specific rules that may influence its implementation across different health care environments.
  11. In summary, meticulous completion and understanding of the DNR order are essential. It safeguards a person’s health care preferences, ensuring they are respected and accurately communicated to those involved in their care.

Documents used along the form

Preparing for future healthcare decisions involves thinking about what types of care you would or would not want, should you be unable to express your wishes. In Arkansas, a Do Not Resuscitate (DNR) Order is a critical document for those who decide they do not want resuscitation efforts if their heart stops or if they stop breathing. However, a DNR is just one piece of the puzzle. There are several other documents and forms that individuals often use alongside a DNR to ensure their healthcare wishes are fully outlined and respected. Here is a list of these documents and a brief description of each.

  • Advance Directive – This document allows individuals to detail their healthcare preferences for end-of-life care, including treatments they do or do not want. It can incorporate a living will and medical power of attorney.
  • Living Will – Specific to end-of-life decisions, a living will outlines the types of medical treatments and life-sustaining measures an individual wants or does not want if they are permanently unconscious or terminally ill and cannot make decisions for themselves.
  • Medical Power of Attorney (Healthcare Proxy) – This legal document appoints someone else to make healthcare decisions on an individual's behalf if they are incapable of making decisions for themselves.
  • Physician Orders for Life-Sustaining Treatment (POLST) – A POLST form complements a DNR order but is more comprehensive. It addresses other types of critical care decisions, like feeding tubes and antibiotics, based on current health conditions.
  • Hippa Release Form – This form allows healthcare providers to share an individual’s health information with specified people or organizations under the Health Insurance Portability and Accountability Act (HIPAA).
  • Emergency Medical Information Form – Often kept in a wallet or posted in a home, this form provides emergency personnel with vital health information quickly in an emergency.
  • Organ and Tissue Donation Form – Specifies an individual's wishes regarding organ and tissue donation at the time of their death.
  • Portable Medical Order – Similar to a POLST, this document is intended for those with serious health conditions. It outlines the patient’s wishes for life-sustaining treatments in a form that can be easily transported and recognized across different care settings.
  • Last Will and Testament – While not directly related to healthcare decisions, a last will and testament can ensure an individual’s personal and financial affairs are in order, further alleviating the burden on loved ones during difficult times.
  • Financial Power of Attorney – Designates someone to manage an individual's financial affairs should they become incapacitated, ensuring finances are handled according to the individual's wishes.

When taken together, these documents can provide a comprehensive plan for your healthcare and personal affairs, ensuring your wishes are respected and minimizing the burden on your family during challenging times. Discussing your wishes with your family and healthcare providers, and periodically reviewing and updating your documents, can help ensure that your healthcare plan keeps pace with your changing needs and circumstances.

Similar forms

The Arkansas Do Not Resuscitate (DNR) Order form is similar to a living will, in essence. Both allow individuals to outline their preferences regarding medical treatment should they become unable to communicate their wishes directly. A living will generally covers a broader range of medical interventions, whereas a DNR specifically addresses the wishes concerning resuscitation attempts.

Another document that shares common ground with the Arkansas DNR Order is the medical power of attorney (POA). This legal document enables an individual to appoint someone else to make healthcare decisions on their behalf if they're incapacitated. While the medical POA can encompass the authority to enforce or void a DNR order, the DNR order itself directly communicates a person's wish not to undergo CPR or advanced cardiac life support.

Similarly, a POLST (Physician Orders for Life-Sustaining Treatment) form also parallels the DNR order in its purpose and function. POLST is designed for seriously ill patients and provides a set of medical orders about life-sustaining treatments. Like a DNR, a POLST is used to indicate a patient's preferences about resuscitation and other life-sustaining measures. However, POLST forms are more comprehensive and apply to a wider range of medical interventions beyond CPR.

An advance directive combines elements of a living will and a medical POA, closely relating to the Arkansas DNR Order's intentions. Advance directives allow individuals to document their healthcare preferences and designate a decision-maker in case they're unable to make decisions themselves. While this document encompasses a broader spectrum of healthcare decisions, including those about life-sustaining treatment mentioned in a DNR, it provides a cohesive strategy for managing a person's healthcare wishes in various medical scenarios.

Dos and Don'ts

Filling out the Arkansas Do Not Resuscitate (DNR) Order form is an important step for those who wish to make clear their wishes regarding the extent of medical interventions they desire in case of a life-threatening situation. It is crucial that the form is completed accurately to ensure that these wishes are respected. Here are several do's and don'ts to consider when filling out the DNR order form in Arkansas.

  • Do ensure that you have accurate and complete personal information at hand. This includes your full legal name, date of birth, and a clear understanding of your medical conditions.
  • Do discuss your decision with a healthcare provider. It’s important to have a thorough understanding of what a DNR order entails and how it affects your medical treatment options.
  • Do have the form reviewed by a legal advisor if you have any uncertainties. This can provide clarity and ensure that your rights are protected.
  • Do keep the completed form in an easily accessible location and inform your family members or caregivers of its existence and location.
  • Don't fill out the form on your own if you are unsure about any of the sections. Seek clarification from a healthcare professional or legal advisor.
  • Don't forget to sign and date the form. For the DNR order to be effective, it must include your signature or that of your legally authorized representative if you are unable to sign it yourself.
  • Don't leave parts of the form blank if they are applicable to you. Make sure every relevant section is completed to avoid potential confusion or disputes about your wishes.
  • Don't fail to communicate your decision to implement a DNR order to all involved in your care, including your family, friends, and healthcare providers. This ensures that everyone is aware of your wishes and can act accordingly.

By following these guidelines, individuals can be more confident that their preferences regarding resuscitation will be fully understood and respected. Remember, completing a DNR order is a personal decision, and it is one that should be made after careful consideration and discussion with knowledgeable professionals and loved ones.

Misconceptions

When it comes to the Arkansas Do Not Resuscitate (DNR) Order form, several misconceptions often arise. Clearing up these misunderstandings is crucial to ensure that individuals make informed decisions regarding their end-of-life care preferences.

  • Only the elderly can have a DNR order. People often think that DNR orders are only for the elderly, but in reality, individuals of any age with severe health conditions may consider a DNR order appropriate.

  • DNR orders deny all types of medical treatment. A common misconception is that a DNR order means no medical intervention will be provided. However, it specifically refers to not performing cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.

  • DNR orders are permanent and cannot be changed. Some people believe once a DNR order is placed, it cannot be revoked or modified. In truth, a DNR order can be updated or canceled by the patient or their authorized representative at any time to reflect their current wishes.

  • A DNR order is only applicable in a hospital. There's a misconception that DNR orders are only effective in hospital settings. Actually, Arkansas DNR orders can be valid in multiple settings, including at home, as long as they are properly documented and accessible to healthcare providers.

  • A doctor's consent is not needed to create a DNR order. Many believe that they can establish a DNR order on their own. Contrary to this belief, a DNR order must be discussed with and signed by a licensed physician to be legally valid.

  • DNR orders are the same as living wills. It's often thought that a DNR order and a living will are the same document. While both address end-of-life care, a living will is broader, detailing a person's wishes for various medical treatments, whereas a DNR specifically instructs healthcare providers not to perform CPR.

  • Emergency services will not respond if you have a DNR order. Some people worry that calling emergency services will be futile if they have a DNR order. Emergency teams will still respond and provide all necessary care aside from CPR if a DNR order is presented.

  • Having a DNR means you won't be admitted to a hospital. The misconception here is that hospitals will refuse admission to patients with DNR orders. In reality, these orders do not affect the decision to admit patients for treatment of illnesses or injuries that do not require CPR.

  • A DNR order must be notarized to be valid. Some may think that notarization is a requirement for DNR orders. The truth is, in Arkansas, notarization is not necessary for a DNR order to be legally effective; it only needs to be properly signed and witnessed.

  • DNR orders cover decisions about food and water. A common misunderstanding is that DNR orders also apply to the provision of nutrition and hydration. However, DNR orders strictly address the non-provision of CPR and do not affect other supportive measures like feeding and hydration.

Understanding these facts about the Arkansas Do Not Resuscitate Order can help individuals and their families make more informed decisions that align with their health care preferences and values.

Key takeaways

Understanding the Arkansas Do Not Resuscitate (DNR) Order form is vital for ensuring that a person's medical care preferences are honored in critical situations. Here are key takeaways about filling out and using this form:

  • The DNR order must be filled out by a licensed physician. This ensures that the individual's health status and wishes are accurately documented and deemed medically appropriate.
  • It's essential for the person, or their legal representative, to discuss their wishes in depth before completing the form. This discussion helps clarify the purpose and consequences of a DNR order.
  • Both the patient and the physician must sign the form, signifying mutual agreement and understanding of the order’s implications.
  • Once signed, the DNR form should be kept in an easily accessible location. In an emergency, healthcare providers need to find it quickly to honor the patient's wishes.
  • Inform family members and any caregivers about the existence and location of the DNR order. Clear communication can prevent confusion or delays in an emergency.
  • A DNR order can be revoked or updated at any time. If the individual changes their mind, it's crucial to communicate this change to the physician and amend the documentation accordingly.
  • The DNR order should be reviewed periodically, especially if the individual’s health status changes. What might have been a clear decision at one point can shift with new health information or changes in perspective.
  • Carry a wallet-sized DNR card as a convenient way to alert healthcare providers about the DNR status in situations outside the home.
  • In Arkansas, the DNR order is specific to not performing cardiopulmonary resuscitation (CPR) if breathing stops or if the heart stops beating. It does not affect other forms of medical care. Understanding this distinction is vital.
  • Finally, consider the emotional impact of a DNR order on loved ones. While it's a personal decision, discussing it with family can help manage any emotional fallout or misunderstandings that may arise later.

Properly handling a DNR order can profoundly impact end-of-life care and the respect of an individual’s healthcare preferences. Therefore, ensuring clarity and understanding around this document is crucial for all involved parties.

Please rate Attorney-Approved Do Not Resuscitate Order Form for Arkansas Form
4.69
(Exceptional)
235 Votes

Other Arkansas Templates