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Blank Do Not Resuscitate Order Form for Wisconsin State

A Wisconsin Do Not Resuscitate 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 provides clarity for healthcare providers and loved ones, ensuring that a person's preferences are respected when they are unable to communicate. Understanding and completing this form can be an important step in planning for future healthcare needs.

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Table of Contents

Document Overview

Fact Name	Details
Governing Law	The Wisconsin Do Not Resuscitate Order is governed by Wisconsin Statutes § 154.03.
Purpose	This form allows individuals to express their wish not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Eligibility	Any adult, or a minor with parental consent, can complete a Do Not Resuscitate Order in Wisconsin.
Signature Requirement	The order must be signed by the individual or their authorized representative, and a physician must also sign it.
Validity	The DNR order remains valid until revoked by the patient or their representative, or until the physician determines it is no longer applicable.
Distribution	Copies of the signed DNR order should be provided to emergency medical services, healthcare providers, and kept in the patient's medical record.

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Discover More Do Not Resuscitate Order Templates for Specific States

Georgia Do Not Resuscitate Form - Can vary by jurisdiction; always consult relevant laws for specific requirements.

Dnr Comfort Care - Designed to prevent aggressive medical interventions in terminal situations, reflecting personal wishes.

Dnr and Dni Documents Are All Part of What Are Known as - Filling out a Do Not Resuscitate Order can help relieve stress for family members during a crisis.

Documents used along the form

When considering end-of-life care options, it is important to have the appropriate documentation in place. In Wisconsin, the Do Not Resuscitate (DNR) Order form is a key document, but there are several other forms that can complement it. Each of these documents serves a specific purpose in ensuring that a person's healthcare wishes are respected.

Advance Directive: This document outlines a person's preferences for medical treatment in situations where they may not be able to communicate their wishes. It can include instructions on life-sustaining treatments and appoints a healthcare agent to make decisions on behalf of the individual.
Power of Attorney for Health Care: This form allows an individual to designate someone they trust to make healthcare decisions for them if they become incapacitated. It is a vital part of planning for future medical care.
Living Will: A living will specifies the types of medical treatment an individual wishes to receive or refuse in the event of a terminal illness or severe injury. It is often used in conjunction with the DNR Order to provide clear guidance on treatment preferences.
Physician Orders for Life-Sustaining Treatment (POLST): This document translates a patient's wishes regarding life-sustaining treatment into actionable medical orders. It is designed for individuals with serious health conditions and is recognized by healthcare providers across Wisconsin.

Having these documents in place can provide peace of mind for individuals and their families. They ensure that personal healthcare preferences are known and respected, allowing for a more dignified approach to medical care at critical moments.

Document Sample

Wisconsin Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order has been created in accordance with Wisconsin state law. This document conveys the wishes of the individual named below regarding resuscitation efforts in the event of cardiac arrest or respiratory failure.

Patient Information:

Name: ________________________
Date of Birth: ________________________
Address: ________________________
City: ________________________
State: Wisconsin
Zip Code: ________________________

Physician Information:

Name: ________________________
License Number: ________________________
Contact Information: ________________________

Order Statement:

This DNR Order indicates the following:

The patient does not wish to receive cardiopulmonary resuscitation (CPR) in case of cardiac arrest.
The patient does not wish to receive advanced airway management or artificial ventilation in the event of respiratory failure.

Legal Considerations:

This Order is valid only when signed by the patient or the legally authorized representative and the attending physician. It must be retained in the patient’s medical records for validation.

Signatures:

Patient or Authorized Representative Signature: ________________________

Date: ________________________

Physician Signature: ________________________

Date: ________________________

This document should be reviewed annually or whenever the patient's health status changes significantly.