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Blank Do Not Resuscitate Order Form for Georgia State

A Georgia Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to refuse resuscitation efforts in the event of a medical emergency. This form is crucial for ensuring that a person's end-of-life wishes are respected by medical professionals. To take control of your healthcare decisions, consider filling out the DNR form by clicking the button below.

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Table of Contents

Document Overview

Fact Name	Details
Definition	A Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Governing Law	The Georgia DNR Order is governed by the Georgia Code, specifically O.C.G.A. § 31-39-1 through § 31-39-7.
Eligibility	Any adult or legally authorized representative can complete a DNR Order in Georgia. This includes individuals with terminal illnesses or those who wish to avoid resuscitation.
Form Requirements	The DNR Order must be signed by the patient or their representative and a physician. It should also include specific identification details of the patient.
Distribution	Once completed, the DNR Order should be provided to the patient’s healthcare providers and kept in a visible location within the patient’s medical records.
Revocation	A DNR Order can be revoked at any time by the patient or their representative. This can be done verbally or by destroying the document.

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Discover More Do Not Resuscitate Order Templates for Specific States

Dnr and Dni Documents Are All Part of What Are Known as - Customizable based on personal beliefs and medical circumstances.

Dnr Comfort Care - Encourages respect for personal autonomy in medical care decisions and end-of-life scenarios.

Documents used along the form

When considering end-of-life care options, several important documents often accompany the Georgia Do Not Resuscitate Order form. These forms help ensure that a person's healthcare preferences are respected and clearly communicated. Below are a few key documents that may be useful.

Advance Directive for Health Care: This document outlines a person's wishes regarding medical treatment in case they become unable to communicate. It allows individuals to specify their preferences for life-sustaining treatments and appoint a healthcare agent to make decisions on their behalf.
Living Will: A living will is a type of advance directive that specifically addresses end-of-life care. It details the types of medical treatments a person does or does not want if they are terminally ill or in a persistent vegetative state.
Healthcare Power of Attorney: This document designates someone to make healthcare decisions for an individual if they are unable to do so themselves. It ensures that a trusted person can advocate for the individual's wishes regarding medical treatment.
Physician Orders for Life-Sustaining Treatment (POLST): A POLST form is a medical order that translates a patient’s preferences into actionable physician orders. It is especially useful for those with serious health conditions, ensuring that their treatment preferences are followed in emergency situations.

Having these documents in place can provide peace of mind for individuals and their families. They help ensure that healthcare decisions align with personal values and preferences, promoting dignity and respect during challenging times.

Document Sample

Georgia Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is created in accordance with Georgia state law. Please provide the necessary details in the blanks below.

Patient Information:

Patient Name: ____________________________
Date of Birth: ____________________________
Address: _______________________________
Phone Number: _________________________

Physician Information:

Physician Name: ____________________________
Practice Name: ______________________________
Phone Number: ______________________________
Date of Order: ____________________________

Statement of Intent:

I, the undersigned patient, do hereby declare that I do not wish to receive cardiopulmonary resuscitation (CPR) or any other life-sustaining treatment in the event of cardiac arrest. It is my wish that if my heart stops or I stop breathing, I am to be allowed to die naturally.

Patient Signature: ____________________________

Date: ______________________________

Witness Signatures:

____________________________ (Name & Signature)
____________________________ (Name & Signature)

This document must be honored by healthcare providers in accordance with Georgia law. It should be kept in a prominent place and shared with family and medical personnel.