Blank Do Not Resuscitate Order Form for Illinois State Fill Out Your Document

Blank Do Not Resuscitate Order Form for Illinois State

The Illinois Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. By completing this form, a person can communicate their desire to forgo life-saving measures such as CPR. If you or a loved one wish to ensure your healthcare preferences are respected, consider filling out the DNR form by clicking the button below.

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Table of Contents

Document Overview

Fact Name Details
Definition The Illinois Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to refuse cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Governing Law The Illinois DNR Order is governed by the Illinois DNR Law, found in the Illinois Compiled Statutes, 410 ILCS 50/1 et seq.
Eligibility Any adult who is capable of making their own healthcare decisions can complete a DNR Order. This includes individuals with terminal illnesses or severe health conditions.
Signature Requirement The form must be signed by the individual or their legally authorized representative. A physician's signature is also required to validate the order.
Form Availability The Illinois DNR Order form is available through healthcare providers, hospitals, and online resources from the Illinois Department of Public Health.
Revocation Individuals can revoke a DNR Order at any time. This can be done verbally or by destroying the written document.
Emergency Medical Services (EMS) Compliance EMS personnel are required to honor a valid DNR Order when they arrive at the scene and the order is presented.
Limitations The DNR Order applies only to CPR and does not affect other medical treatments or interventions that may be necessary for the patient.
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What Is Dnr Mean - A DNR allows patients to exercise control over their medical treatment in emergencies.

Dnr and Dni Documents Are All Part of What Are Known as - Can be created in advance or discussed with healthcare providers.

Dnr Form California - The existence of a DNR can guide healthcare teams in making appropriate decisions if emergencies arise.

Documents used along the form

In Illinois, the Do Not Resuscitate (DNR) Order form is an important document that reflects a person's wishes regarding medical treatment in emergencies. However, it often works in conjunction with several other forms and documents that can provide a more comprehensive view of an individual's healthcare preferences. Below is a list of commonly used documents that complement the DNR Order.

  • Living Will: This document outlines a person's preferences for medical treatment in situations where they are unable to communicate their wishes. It typically addresses end-of-life care and can include preferences for pain management and other life-sustaining treatments.
  • Healthcare Power of Attorney: This form designates a trusted individual to make healthcare decisions on behalf of the person if they become incapacitated. It ensures that someone who understands the individual’s values and wishes can advocate for their care.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that specifies the types of life-sustaining treatments a person wants or does not want. Unlike a DNR, it is more comprehensive and can address a range of medical interventions.
  • Advance Directive: This is a broader term that encompasses both living wills and healthcare powers of attorney. It allows individuals to express their healthcare preferences in advance, ensuring their wishes are known and respected.
  • Do Not Intubate (DNI) Order: Similar to a DNR, this order specifically states that a patient does not wish to be intubated or placed on a ventilator in the event of respiratory failure.
  • Emergency Medical Services (EMS) DNR Form: This form is used by emergency responders to quickly identify a person's DNR status in emergency situations. It is often displayed prominently in the home or carried by the individual.
  • Patient Advocate Designation: This document allows individuals to appoint someone to act on their behalf regarding medical decisions, especially in situations where they cannot speak for themselves.
  • Organ Donation Registration: This form indicates a person’s wishes regarding organ donation after death. It can be included with other advance directives to provide a complete picture of a person's healthcare preferences.
  • Medical History and Medication List: While not a legal document, having a comprehensive medical history and current medication list can help healthcare providers make informed decisions in emergencies.

Understanding these documents and how they work together can empower individuals to make informed decisions about their healthcare. It is essential to communicate these preferences with family members and healthcare providers to ensure that wishes are honored during critical times.

Document Sample

Illinois Do Not Resuscitate (DNR) Order

This Do Not Resuscitate Order (DNR) is effective in accordance with Illinois state law, specifically the Illinois DNR law. It reflects the wishes of the patient regarding resuscitation efforts in the event of cardiac or respiratory arrest.

Patient Information:

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

Attending Physician Information:

  • Physician Name: ____________________________
  • Practice Name: ____________________________
  • Phone Number: ____________________________
  • License Number: ____________________________

Patient's Wishes:

It is my wish that the following treatments not be initiated or continued in the event that I experience cardiac or respiratory arrest:

  • Cardiopulmonary Resuscitation (CPR): Yes / No
  • Mechanical Ventilation: Yes / No
  • Defibrillation: Yes / No
  • Other Medical Interventions: ____________________________

Signature:

By signing below, I confirm that I am a competent adult and that this DNR order expresses my wishes regarding resuscitation in accordance with Illinois law.

Patient Signature: ____________________________

Date: ____________________________

Witness Information:

  • Witness Name: ____________________________
  • Signature: ____________________________
  • Date: ____________________________