Tennessee Do Not Resuscitate Order Form
The Tennessee Do Not Resuscitate Order Form allows patients to express their wishes regarding cardiopulmonary resuscitation. This legal document ensures that patients' decisions are respected in emergency situations. It is essential for patients with terminal conditions to communicate their choices clearly.
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How do I fill this out?
To fill out the Tennessee Do Not Resuscitate Order Form, gather the required information about the patient and the attending physician. Ensure that both the patient or their agent and the attending physician sign the document. Finally, keep the form accessible to healthcare providers and emergency personnel.
How to fill out the Tennessee Do Not Resuscitate Order Form?
1
Gather the patient's full name and medical information.
2
Obtain the attending physician's signature and printed name.
3
Complete the patient's statement and signature.
4
Have a witness sign the document.
5
Ensure the form is easily accessible for emergency medical services.
Who needs the Tennessee Do Not Resuscitate Order Form?
1
Patients with terminal illnesses need this form to communicate their end-of-life wishes.
2
Family members seeking to respect the patient's decisions require this document for clarity.
3
Healthcare providers must have this order to follow the patient's instructions efficiently.
4
Legal representatives can use this form to manage the patient's health care preferences.
5
Emergency medical services personnel need this order to understand their obligations during a medical emergency.
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1
Open the PDF on PrintFriendly's editor.
2
Fill in the necessary patient and physician details.
3
Make any additional edits to the document as needed.
4
Review the completed form for accuracy.
5
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What are the important dates for this form in 2024 and 2025?
The Tennessee DNR Order Form remains valid until revoked by the patient or until their death. Regular reviews of such forms are recommended to ensure they reflect the current wishes of the patient. It's advisable to consult with healthcare professionals annually to reaffirm the patient's choices regarding resuscitation.
What is the purpose of this form?
The purpose of the Tennessee Do Not Resuscitate Order Form is to allow patients to document their wishes regarding life-sustaining treatments, particularly CPR. This form is vital for patients diagnosed with terminal illness, providing them a means to communicate their preferences to medical personnel and family members. By clearly outlining these wishes, the form helps ensure that patients' decisions are respected at the end of life.
Tell me about this form and its components and fields line-by-line.
- 1. Patient's Full Name: The full name of the patient who is requesting the DNR.
- 2. Attending Physician's Statement: Statement by the physician confirming they are responsible for the patient's care.
- 3. Date: The date on which the DNR is signed.
- 4. Signature of Witness: Signature of a witness to the patient's request.
- 5. Signature of Patient: Signature from the patient or their legal representative indicating consent.
- 6. Printed Name of Attending Physician: The printed name of the attending physician.
What happens if I fail to submit this form?
Failing to submit a valid Do Not Resuscitate Order may lead to unintended resuscitation efforts during a medical emergency.
- Confusion in Emergency Situations: Without the DNR order, medical personnel may proceed with resuscitation against the patient's wishes.
- Potential Legal Disputes: In the absence of clear documentation, family members may have differing opinions about patient's wishes.
- Increased Stress for Family Members: Family may experience additional anxiety knowing the patient's preferences are not legally documented.
How do I know when to use this form?
- 1. Patients with Terminal Conditions: To express their wish not to receive CPR or life-sustaining measures.
- 2. Family Members of Terminal Patients: To provide clarity in end-of-life care decisions.
- 3. Healthcare Providers: To facilitate appropriate emergency responses in case of patient distress.
Frequently Asked Questions
What is a Do Not Resuscitate Order?
A Do Not Resuscitate Order is a legal document that states a patient's wish not to receive cardiopulmonary resuscitation in case of a medical emergency.
Who can fill out this order?
The order can be filled out by the patient, their agent with durable power of attorney for healthcare, and the attending physician.
Is this form valid in Tennessee?
Yes, this form complies with Tennessee law regarding Do Not Resuscitate Orders.
How do I access the PDF for editing?
Simply click on the PDF link to download and edit it using our online tool.
Can I save the edited PDF document?
You can download the edited document to your device after making changes.
How do I share the PDF with others?
After editing, you can share the PDF directly through email or social media from PrintFriendly.
What if I change my mind about resuscitation?
You can revoke the order at any time by informing your physician or healthcare provider.
Is there a contact for help if I have questions?
For questions, please reach out to your healthcare provider or local EMS.
Can medical personnel override this order?
Emergency medical personnel must honor the DNR order unless it is revoked by the patient.
What happens to this form after the patient's death?
The form becomes part of the patient's EMS medical record and is retained accordingly.
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