Legal Delaware Do Not Resuscitate Order Document Fill Out Form Here

Legal Delaware Do Not Resuscitate Order Document

A Delaware Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding medical treatment in the event of a life-threatening situation. By completing this form, you can indicate that you do not want to receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures. Understanding this form is crucial for ensuring that your healthcare preferences are respected during critical moments.

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Outline

The Delaware Do Not Resuscitate (DNR) Order form is a critical document designed to communicate a patient's wishes regarding resuscitation efforts in the event of a medical emergency. This form is particularly important for individuals with serious health conditions or those who wish to avoid aggressive medical interventions at the end of life. It allows patients to express their preferences clearly, ensuring that healthcare providers respect their choices. The DNR form must be completed and signed by both the patient and a physician, confirming that the patient understands the implications of the decision. In Delaware, this form is recognized by emergency medical services, hospitals, and other healthcare facilities, making it essential for anyone considering end-of-life care options. By understanding the DNR Order form, individuals can take proactive steps to ensure their healthcare aligns with their values and desires during critical moments.

Preview - Delaware Do Not Resuscitate Order Form

The Delaware Do Not Resuscitate Order is a legally binding document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating. This order is specific to the State of Delaware, governed by Delaware laws, and must be fully completed and signed to be effective.

Please provide the necessary information in the spaces provided below to prepare your Delaware Do Not Resuscitate Order.

Patient Information:

  • Full Name: ___________________________________________
  • Date of Birth: _______________________________________
  • Address: _____________________________________________
  • City: ______________________ State: DE Zip: ___________

Medical Information:

  • Primary Physician: ____________________________________
  • Physician Phone: _____________________________________
  • Medical Condition: ____________________________________

Legal Guardian or Health Care Proxy Information (if applicable):

  • Full Name: ___________________________________________
  • Relationship to Patient: ______________________________
  • Phone Number: ________________________________________
  • Address: _____________________________________________
  • City: ______________________ State: DE Zip: ___________

This document reflects the patient's wishes regarding resuscitation. It is valid only when signed by the patient or the patient's legal representative and the patient's physician. By signing this document, all parties agree that the patient should not be resuscitated in the event that their heart stops beating or they stop breathing.

By signing below, I acknowledge that I have been fully informed of the nature and effect of a Do Not Resuscitate Order and I request that no resuscitation efforts be made on my behalf:

____________________________________
Patient Signature (or Legal Representative)

Date: ________________________________

Physician's Acknowledgment:

I, the undersigned physician, affirm that this order reflects the patient's current medical condition and their wishes regarding resuscitation:

____________________________________
Physician's Signature

Date: ________________________________

Instructions for Revocation: A Delaware Do Not Resuscitate Order can be revoked at any time by the patient or their legally authorized representative by informing the attending physician either orally or in writing.

Document Attributes

Fact Name Description
Definition A Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform CPR if a person's heart stops or they stop breathing.
Governing Law The Delaware Do Not Resuscitate Order is governed by Delaware Code Title 16, Chapter 2503.
Eligibility Any adult may complete a DNR Order. This includes individuals who are terminally ill or have a serious medical condition.
Signature Requirement The DNR Order must be signed by the patient or their legal representative to be valid.
Witness Requirement Two witnesses are required to sign the DNR Order, confirming that they observed the signing.
Revocation A DNR Order can be revoked at any time by the patient or their legal representative.
Emergency Medical Services Emergency medical personnel are required to honor a valid DNR Order in the field.
Form Availability The Delaware DNR Order form is available through hospitals, healthcare providers, and state health department websites.
Notification It is important to inform family members and healthcare providers about the existence of a DNR Order.
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