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Blank Do Not Resuscitate Order Form for Kansas State

A Kansas Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in case of a medical emergency. This form ensures that healthcare providers respect a person's decision not to undergo life-saving measures. If you are considering filling out this important document, click the button below to get started.

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Table of Contents

Document Overview

Fact Name	Description
Definition	A Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a person's heart stops beating.
Governing Law	The Kansas Do Not Resuscitate Order is governed by the Kansas Statutes Annotated, specifically K.S.A. 65-4973 through 65-4975.
Eligibility	Any adult with decision-making capacity can complete a DNR order. This includes individuals who are terminally ill or have a serious medical condition.
Form Requirement	The Kansas DNR form must be completed and signed by a physician. It can also be signed by a qualified healthcare provider.
Signature	The order must be signed by the patient or their legal representative to be valid.
Location	The DNR order should be kept in a place where it is easily accessible, such as a hospital chart or on the patient’s person.
Revocation	A DNR order can be revoked at any time by the patient or their representative, either verbally or in writing.
Emergency Medical Services	Emergency medical services (EMS) personnel are required to honor a valid DNR order. They must verify its authenticity before withholding resuscitation.
Advance Directives	A DNR order is a type of advance directive but is specifically focused on resuscitation efforts. It can be part of a broader advance care plan.
Public Awareness	Public awareness about DNR orders is important. Many people may not understand their rights or the implications of such a decision.

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Discover More Do Not Resuscitate Order Templates for Specific States

Dnro - A DNRO is about honoring individual autonomy in healthcare decisions and end-of-life preferences.

Dnr Comfort Care - Empowers patients to take control of their healthcare decisions, particularly in critical moments.

Documents used along the form

The Kansas Do Not Resuscitate (DNR) Order form is an essential document for individuals who wish to communicate their preferences regarding resuscitation efforts in the event of a medical emergency. However, this form is often accompanied by several other important documents that collectively inform healthcare providers about a patient’s wishes. Below is a list of related forms and documents that are commonly used alongside the Kansas DNR Order.

Advance Directive: This document allows individuals to outline their healthcare preferences in advance, including decisions about life-sustaining treatments and appointing a healthcare proxy to make decisions on their behalf if they become unable to do so.
Durable Power of Attorney for Healthcare: This legal document designates a specific person to make healthcare decisions on behalf of the individual when they are incapacitated. It ensures that someone trusted can advocate for the individual’s wishes.
Living Will: A living will is a type of advance directive that specifies what types of medical treatment an individual does or does not want in situations where they are unable to communicate their wishes, particularly in terminal or irreversible conditions.
Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that reflects the patient's preferences for treatment in emergency situations. Unlike a DNR, which specifically addresses resuscitation, a POLST provides a broader scope of treatment preferences.
Hospital Do Not Resuscitate Protocol: This internal hospital document outlines the procedures and guidelines for honoring DNR orders within the hospital setting, ensuring that staff are aware of and comply with the patient’s wishes.
Patient Identification Bracelet: Often used in healthcare settings, this bracelet serves as a visual indicator of a patient’s DNR status. It helps ensure that all healthcare providers are aware of the patient’s resuscitation preferences at a glance.

These documents work in concert to ensure that an individual's healthcare preferences are respected and upheld. By understanding the role of each form, patients and their families can navigate the complexities of medical decision-making with greater confidence and clarity.

Document Sample

Kansas Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is made in compliance with Kansas law K.S.A. 65-4961 et seq.

Patient Information:

Full Name: ____________________________________
Date of Birth: _______________________________
Medical Record Number: ______________________

Statement of DNR Order:

This order is made voluntarily by the patient or their authorized representative. The patient wishes to forego resuscitation in the event of cardiac or respiratory arrest.

In the case of medical emergencies:

No attempts will be made to perform CPR (Cardiopulmonary Resuscitation).
No advanced life support measures will be provided.

Patient's Signature or Authorized Representative's Signature:

__________________________________________________________

Date: ____________________________________________

Witness Information:

Witness Name: __________________________________
Witness Signature: _____________________________
Date: _________________________________________

This order should be prominently displayed on the patient's medical chart and communicated to all healthcare personnel involved in the patient's care.