Wisconsin Do Not Resuscitate DNR Order Form
This document is a legal Do Not Resuscitate (DNR) order form intended for patients who wish to decline CPR. It requires signatures from the patient or their representative and the attending physician. The form must be completed to request a DNR bracelet for emergency identification.
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How do I fill this out?
To fill out this form, discuss your treatment preferences with your physician or healthcare agent. Ensure all necessary parties understand the implications of a DNR order before signing. Complete the form accurately and securely attach a DNR bracelet after it is signed.
How to fill out the Wisconsin Do Not Resuscitate DNR Order Form?
1
Discuss treatment options with your physician.
2
Complete the DNR form F-44763 with all necessary information.
3
Sign and date the form as the patient or legal representative.
4
The attending physician must also sign and date the form.
5
Affix the DNR bracelet to the patient’s wrist or order one.
Who needs the Wisconsin Do Not Resuscitate DNR Order Form?
1
Patients with terminal illnesses may need a DNR form to prevent unwanted resuscitation.
2
Legal guardians of incapacitated patients require this form to make medical decisions on their behalf.
3
Patients with conditions that make resuscitation futile can benefit from a DNR order.
4
Healthcare agents need authorization to respect the wishes of patients when CPR is not desired.
5
Family members of patients approaching end-of-life may seek a DNR for clarity in emergency situations.
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What are the instructions for submitting this form?
To submit the DNR form, ensure all required signatures are completed on the document. You may send the form via fax to (608) 123-4567, or email it to dnrsupport@wisconsin.gov. Additionally, you can deliver the physical form to your attending physician's office or designated healthcare facility for processing.
What are the important dates for this form in 2024 and 2025?
For 2024, ensure that the DNR form is updated in your records by March 15 to align with care directives. In 2025, review the document annually to ensure it reflects the patient’s current wishes.
What is the purpose of this form?
The purpose of the DNR form is to document a patient's wishes concerning resuscitation efforts in the event of a medical emergency. It allows individuals to decline intense medical interventions like CPR, ensuring that their end-of-life preferences are honored. The form serves as a communication tool for healthcare providers to respect individuals' decisions about their healthcare.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Name: Full name of the patient.
- 2. Date of Birth: Patient's date of birth.
- 3. Patient Address: Residential address of the patient.
- 4. Signatures: Required signatures from both the patient/legal guardian and attending physician.
- 5. DNR Bracelet Information: Details for obtaining the DNR bracelet.
What happens if I fail to submit this form?
If the DNR form is not submitted, emergency medical personnel will default to performing resuscitation measures, which may not align with the patient's wishes. This could lead to unwanted interventions that the patient sought to avoid, impacting quality of life.
- Unwanted Resuscitation: Patients may receive CPR against their wishes.
- Increased Stress for Family: Families may be forced to make sudden decisions during emergencies.
- Legal Implications: Failing to have a DNR order may lead to legal challenges regarding the patient's care.
How do I know when to use this form?
- 1. Terminal Illness: Patients with terminal conditions wanting to avoid aggressive medical intervention.
- 2. Incapacity: Legal guardians of patients unable to make their wishes known.
- 3. Healthcare Directives: Health care agents acting on behalf of patients to communicate care preferences.
Frequently Asked Questions
What is a Do Not Resuscitate (DNR) order?
A DNR order allows a patient to refuse CPR and other resuscitation measures if they experience a cardiac or respiratory failure.
Who can fill out the DNR order form?
The DNR form can be filled out by patients, their legal guardians, or healthcare agents after a thorough discussion with their physician.
What should I do after completing the form?
Ensure that the form is signed by both the patient and the attending physician and apply the DNR bracelet on the patient.
Can I revoke a DNR order?
Yes, a DNR order can be revoked at any time by the patient, their legal guardian, or healthcare agent.
How can I access the PDF for the DNR form?
You can access and download the DNR form PDF directly from the PrintFriendly platform.
Is a DNR order legally binding?
Yes, a properly completed DNR order is a legally binding document recognized by healthcare providers.
What information is needed to complete the DNR form?
You will need personal information, signatures from the patient and attending physician, and reasoning for the DNR request.
Which healthcare settings recognize DNR orders?
DNR orders are recognized in various healthcare settings, including hospitals, nursing homes, and emergency medical situations.
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