Printable Do Not Resuscitate Order Template for Arkansas Fill Out Form Online

Printable Do Not Resuscitate Order Template for Arkansas

A Do Not Resuscitate (DNR) Order is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. In Arkansas, this form is essential for ensuring that healthcare providers respect a person's preferences about life-saving measures. Understanding the nuances of the Arkansas DNR Order can provide peace of mind for individuals and their families during difficult times.

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Dos and Don'ts

When filling out the Arkansas Do Not Resuscitate Order form, it is important to follow certain guidelines to ensure that your wishes are clearly communicated. Here’s a list of things you should and shouldn’t do:

  • Do ensure you understand the implications of a Do Not Resuscitate (DNR) order.
  • Do fill out the form completely and accurately.
  • Do sign and date the form in the appropriate sections.
  • Do discuss your decision with your healthcare provider and family.
  • Don’t use a DNR form without proper understanding of your medical condition.
  • Don’t forget to keep copies of the completed form for your records and to share with your healthcare team.

Important Details about Arkansas Do Not Resuscitate Order

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

A Do Not Resuscitate Order (DNR) in Arkansas is a legal document that allows individuals to refuse cardiopulmonary resuscitation (CPR) and other life-saving measures in the event of a medical emergency. This order is particularly relevant for patients who have a terminal illness or a medical condition that significantly diminishes their quality of life. It ensures that their wishes regarding end-of-life care are respected by healthcare providers.

Who can request a DNR Order in Arkansas?

In Arkansas, a DNR Order can be requested by individuals who are at least 18 years old and are capable of making informed decisions about their medical care. Additionally, a legal guardian or an authorized representative can request a DNR Order on behalf of an individual who is unable to make such decisions due to incapacity. It is essential that the individual’s wishes are clearly communicated and documented.

How do I obtain a DNR Order form in Arkansas?

The DNR Order form can be obtained from various sources, including:

  1. Healthcare providers, such as hospitals and clinics.
  2. State health department websites, which often provide downloadable forms.
  3. Legal assistance organizations that specialize in healthcare law.

Once the form is acquired, it must be filled out accurately and signed to be valid. It is advisable to consult with a healthcare professional when completing the form to ensure that all necessary information is included.

What should I do after completing the DNR Order form?

After completing the DNR Order form, it is crucial to take several steps to ensure that your wishes are honored:

  • Keep the original signed document in a safe but accessible place.
  • Provide copies of the DNR Order to your healthcare providers, family members, and anyone involved in your care.
  • Consider wearing a medical alert bracelet or necklace that indicates your DNR status.

By taking these steps, you help ensure that your wishes regarding resuscitation are clear and can be easily followed in an emergency.

Can a DNR Order be revoked or changed?

Yes, a DNR Order can be revoked or changed at any time by the individual who signed it. If you decide to change your mind about the DNR Order, simply inform your healthcare providers and ensure that they have the most current version of your wishes. It is advisable to formally revoke the existing order in writing and to communicate this change to all relevant parties.

What happens if a DNR Order is not available during an emergency?

If a DNR Order is not available during a medical emergency, healthcare providers are required to perform life-saving measures, including CPR. This is why it is vital to ensure that the DNR Order is easily accessible and that those involved in your care are aware of your wishes. Keeping a copy of the order in your medical records and informing family members can help prevent any confusion in critical situations.

Example - Arkansas Do Not Resuscitate Order Form

Arkansas Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is made in accordance with the laws of the state of Arkansas. It expresses the individual's wishes regarding resuscitation in the event of cardiac or respiratory arrest.

Patient Information:

  • Full Name: ______________________________
  • Date of Birth: __________________________
  • Address: _______________________________
  • Phone Number: _________________________

Healthcare Provider:

  • Provider's Name: _______________________
  • Provider's Phone Number: ______________

Patient's Wishes:

I, ______________________, being of sound mind, hereby declare that, in the event of my cardiac or respiratory arrest, I do not wish to receive cardiopulmonary resuscitation (CPR) or other resuscitative measures.

Signature:

_____________________________ Date: ________________

Witness Information:

  • Witness Name: __________________________
  • Witness Signature: ______________________
  • Date: __________________________________

This order is effective immediately and remains in effect until revoked or modified by the patient.

For further guidance or support, please consult with a healthcare professional or legal advisor.