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Blank Do Not Resuscitate Order Form for Washington State

A Washington Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form ensures that healthcare providers respect a person's decision to forgo life-saving measures, focusing instead on comfort and quality of life. If you want to make your preferences known, consider filling out the 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 medical order that prevents healthcare providers from performing cardiopulmonary resuscitation (CPR) if a patient's heart stops or they stop breathing.
Governing Law	In Washington, DNR orders are governed by RCW 70.122, which outlines the requirements and procedures for creating and honoring these orders.
Eligibility	Any adult who is capable of making healthcare decisions can complete a DNR order. This includes individuals with terminal illnesses or severe medical conditions.
Form Requirements	The DNR order must be signed by the patient or their legal representative and a physician. It should be completed on the official Washington DNR form.
Location of Form	The completed DNR form should be kept in an easily accessible location, such as with the patient’s medical records or on their person.
Revocation	A DNR order can be revoked at any time by the patient or their representative. This can be done verbally or in writing.
Emergency Services	Emergency medical services (EMS) personnel are required to honor valid DNR orders. They will check for the presence of the DNR form before administering CPR.

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Dnr and Dni Documents Are All Part of What Are Known as - Signing a Do Not Resuscitate Order can prevent unwanted resuscitation efforts that may lead to unnecessary suffering.

Dnro - This form should be discussed thoroughly with healthcare providers to ensure understanding and compliance.

Documents used along the form

When considering a Washington Do Not Resuscitate (DNR) Order, it's important to understand that this document often works in conjunction with several other forms and documents. Each of these plays a crucial role in ensuring that your healthcare preferences are respected and followed. Below are some commonly used documents that complement a DNR order.

Advance Directive: This document allows individuals to outline their preferences for medical treatment in case they become unable to communicate their wishes. It can include instructions about life-sustaining treatments, organ donation, and other healthcare decisions.
Healthcare Power of Attorney: This form designates a trusted person to make medical decisions on your behalf if you are incapacitated. This agent can ensure that your healthcare wishes, including those related to a DNR, are honored.
Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that outlines a patient's preferences for life-sustaining treatments. Unlike a DNR, which focuses solely on resuscitation, a POLST addresses a broader range of medical interventions and is designed to be honored by healthcare providers in emergency situations.
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 you would or would not want in situations where you are terminally ill or in a persistent vegetative state.

Understanding these documents can help ensure that your healthcare wishes are clearly communicated and respected. Taking the time to prepare these forms can provide peace of mind for you and your loved ones, knowing that your preferences will be honored in critical situations.

Document Sample

Washington Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is made in accordance with Washington state law, allowing individuals to express their wishes regarding medical treatment in emergencies. Below is a template for your use. Please fill in the blanks with your specific information.

Patient Information:

Name: ______________________________________
Date of Birth: ______________________________
Address: ____________________________________
Contact Number: ____________________________

Health Care Provider Information:

Name of Health Care Provider: _________________
Facility Name: _______________________________
Address: ____________________________________
Contact Number: ____________________________

Order Statement:

I, the undersigned, hereby declare that I do not wish to receive resuscitation attempts in the event of cardiac or respiratory arrest. I understand that this means that if my heart stops beating or I stop breathing, no attempts will be made to restart my heart or breathing.

Patient Signature: ____________________________________

Date: _______________________________________________

Healthcare Proxy/Representative (if applicable):

Name: ______________________________________
Relationship to Patient: ____________________
Signature: __________________________________
Date: ______________________________________

It is important to share this document with your healthcare provider and any family members involved in your care. Keep a copy in an accessible location, and ensure that your wishes are known. This DNR Order can provide peace of mind to you and your loved ones during critical times.

Remember, your preferences matter and deserve respect. This document should be discussed thoroughly with your healthcare team to ensure clarity and understanding of your wishes.