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

Blank Do Not Resuscitate Order Form for Ohio State

A Do Not Resuscitate (DNR) Order form in Ohio 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, you can ensure that your preferences for medical treatment are respected. 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 Description
Definition The Ohio Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation efforts in the event of a medical emergency.
Governing Law This form is governed by Ohio Revised Code § 2133.21, which outlines the legal framework for advance directives.
Eligibility Any adult, or a minor with parental consent, can complete the DNR Order form to express their wishes regarding resuscitation.
Signature Requirements The form must be signed by the individual or their legal representative, and it must also be witnessed by two adults or notarized.
Distribution Once completed, copies of the DNR Order should be provided to healthcare providers, family members, and kept in a visible location.
Download Do Not Resuscitate Order PDF Form

Discover More Do Not Resuscitate Order Templates for Specific States

What Is Dnr Mean - This order is a powerful tool for ensuring that health care reflects individual values and wishes.

Dnro - A DNR is a personal choice and should reflect the individual's values and healthcare wishes.

How to Get a Dnr Bracelet - Completing a DNR form is a significant step toward proactive health care planning.

Georgia Do Not Resuscitate Form - Can be revoked or modified at any time as long as the patient is competent to make changes.

Documents used along the form

When preparing a Do Not Resuscitate (DNR) Order in Ohio, several other forms and documents may be necessary to ensure that your healthcare wishes are clearly communicated. Below is a list of these documents, each serving an important role in the overall planning process.

  • Advance Directive: This document outlines your preferences for medical treatment in case you become unable to communicate your wishes. It can include details about life-sustaining treatments and other healthcare decisions.
  • Healthcare Power of Attorney: This form designates an individual to make healthcare decisions on your behalf if you are unable to do so. It is crucial for ensuring that someone you trust can advocate for your wishes.
  • Living Will: A living will specifies your preferences regarding end-of-life care. It provides guidance on the types of medical treatments you want or do not want, especially in terminal situations.
  • Physician Orders for Life-Sustaining Treatment (POLST): This document translates your wishes regarding resuscitation and other life-sustaining measures into actionable medical orders, ensuring healthcare providers follow your preferences.
  • Patient Advocate Designation: This form allows you to appoint a patient advocate to assist in making healthcare decisions and ensure that your wishes are respected throughout your care.
  • Do Not Intubate (DNI) Order: This order specifies that you do not wish to be intubated if you are unable to breathe on your own. It complements the DNR order by addressing specific interventions.
  • Organ Donation Registration: If you wish to donate your organs after death, this document expresses your consent. It is important to communicate your intentions clearly to avoid confusion during critical times.

These documents work together to create a comprehensive plan for your healthcare preferences. It is essential to review and update them regularly to ensure they accurately reflect your wishes.

Document Sample

Ohio Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order is designed to ensure that an individual's wishes regarding medical care are respected according to Ohio law. It allows a person to refuse resuscitation efforts in the event of a medical crisis.

Patient Information:

  • Name: ____________________________
  • Date of Birth: ______________________
  • Address: ___________________________
  • City, State, Zip: ______________________

Primary Physician Information:

  • Name: ____________________________
  • Phone Number: ________________________

Patient's Wishes:

The patient above does not wish to receive cardiopulmonary resuscitation (CPR) in the event of:

  • Cardiac arrest
  • Respiratory failure

Signature:

The patient or legally authorized representative must sign below to validate this DNR order:

  • Signature of Patient or Representative: __________________________
  • Date: ______________________

Witness Information:

Two witnesses must sign the form to ensure the authenticity of the order:

  1. Name: ____________________________ Signature: _______________________ Date: ________________
  2. Name: ____________________________ Signature: _______________________ Date: ________________

Additional Notes:

It is important to keep a copy of this document in a location accessible to healthcare providers. Please communicate this decision with family members and your healthcare team.

**This document is created in accordance with Ohio Revised Code, Section 2133.21.**