Free Ohio Do Not Resuscitate Order Template

A Do Not Resuscitate (DNR) Order form in Ohio allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This legal document ensures that healthcare providers respect a person's decision not to undergo life-saving measures. Understanding and completing this form is crucial for anyone who wishes to have control over their medical care.

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The Ohio Do Not Resuscitate (DNR) Order form serves as a critical document for individuals who wish to express their preferences regarding medical interventions in the event of a life-threatening situation. This form is particularly significant for patients with terminal illnesses or those who have made informed decisions about their end-of-life care. The DNR Order indicates that cardiopulmonary resuscitation (CPR) should not be performed if the individual's heart stops beating or if they stop breathing. In Ohio, the DNR Order must be completed by a physician and signed by both the patient or their legal representative and the physician. It is essential for healthcare providers to recognize and respect this order, as it reflects the patient’s wishes regarding resuscitation efforts. Additionally, the form must be readily accessible, as it is crucial for emergency medical personnel to have it on hand when responding to medical emergencies. Understanding the implications of the DNR Order can empower individuals to make informed choices about their healthcare and ensure that their wishes are honored during critical moments.

Documents used along the form

When individuals or their families make decisions about end-of-life care, they often consider several important documents alongside the Ohio Do Not Resuscitate (DNR) Order. These documents help ensure that a person's wishes are respected and that medical professionals understand their preferences. Below are some common forms used in conjunction with the DNR Order.

Advance Directive: This document allows individuals to outline their preferences for medical treatment in situations where they cannot communicate their wishes. It typically includes instructions about life-sustaining treatments and appoints a healthcare proxy to make decisions on their behalf.
Living Will: A living will is a specific type of advance directive that details what medical treatments an individual does or does not want at the end of life. It provides clear guidance to healthcare providers and family members regarding the individual's desires in critical situations.
Healthcare Power of Attorney: This legal document designates a trusted person to make healthcare decisions for someone if they become unable to do so themselves. This agent can make choices about medical treatment, including those related to the DNR Order.
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Physician Orders for Life-Sustaining Treatment (POLST): The POLST form translates a patient’s wishes regarding life-sustaining treatment into actionable medical orders. Unlike a DNR, which is primarily about resuscitation, the POLST addresses a broader range of medical interventions.

Understanding these documents can empower individuals and families to make informed decisions about healthcare preferences. Together, they create a comprehensive approach to managing end-of-life care, ensuring that personal wishes are honored and respected.

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Ohio Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is created in accordance with Ohio law, specifically under the Ohio Revised Code Section 2133.21. This document allows an individual to express their wishes regarding resuscitation in case of a medical emergency.

Please fill in the necessary information below:

Patient's Full Name: ____________________________
Patient's Date of Birth: ____________________________
Patient's Address: ____________________________
Patient's Medical Record Number: ____________________________

I, the undersigned, am the patient, or I am the authorized representative of the patient named above.

Statement of Wishes:

If the patient suffers a cardiac arrest or respiratory failure, I do not wish for resuscitation to be performed. This includes, but is not limited to:

Cardiac compressions
Artificial ventilation
Administration of medications meant to restore heart function

Signatures:

Signature of Patient or Authorized Representative: ____________________________
Date: ____________________________
Witness Signature: ____________________________
Date: ____________________________

This DNR Order must be signed and dated by the patient, or an authorized representative, and a witness. It is advisable to provide copies of this document to all healthcare providers involved in the patient's care.

By signing this document, the patient, or authorized representative, is ensuring that their wishes regarding resuscitation are clearly communicated and respected.

Guidelines on How to Fill Out Ohio Do Not Resuscitate Order

Completing the Ohio Do Not Resuscitate Order (DNR) form is a critical step for individuals wishing to express their preferences regarding medical treatment in emergency situations. After filling out the form, it’s essential to ensure that it is signed and dated appropriately, as this document will guide healthcare providers in honoring your wishes.

Obtain the Ohio Do Not Resuscitate Order form. You can find this form online or request it from your healthcare provider.
Begin by filling in your personal information at the top of the form. This includes your full name, date of birth, and address.
Designate a decision-maker by providing their name and contact information. This person will be responsible for ensuring that your wishes are followed.
Clearly indicate your wishes regarding resuscitation by checking the appropriate box. You may have options such as “Do Not Resuscitate” or “Allow Resuscitation.”
Sign and date the form. Your signature confirms that you understand the implications of your choices.
If applicable, have your decision-maker sign the form as well. Their signature may be required to validate your choices.
Make copies of the completed form. Keep one copy for yourself and provide copies to your healthcare provider and decision-maker.

Similar forms

The Ohio Do Not Resuscitate (DNR) Order form shares similarities with a Living Will. A Living Will allows individuals to express their wishes regarding medical treatment in situations where they are unable to communicate. Both documents aim to ensure that a person’s preferences for end-of-life care are respected. While a DNR specifically addresses resuscitation efforts, a Living Will covers a broader range of medical interventions, including the use of life-sustaining treatments.

Another document similar to the DNR is the Medical Power of Attorney. This legal document designates an individual to make healthcare decisions on behalf of another person if they become incapacitated. Like the DNR, it focuses on ensuring that a person’s healthcare preferences are honored. The key difference lies in the scope; the Medical Power of Attorney can encompass a wide array of medical decisions, while the DNR is limited to resuscitation efforts.

The Physician Orders for Life-Sustaining Treatment (POLST) form is also comparable to the Ohio DNR. The POLST form translates a patient’s preferences regarding life-sustaining treatments into actionable medical orders. Both documents serve to communicate a patient’s wishes to healthcare providers, but POLST is typically used for patients with serious illnesses, providing a more detailed approach to treatment preferences beyond just resuscitation.

A similar document is the Advance Directive. This legal document allows individuals to outline their healthcare preferences and appoint a healthcare proxy. The Advance Directive can include instructions about resuscitation, making it similar to the DNR. However, it often covers a wider range of healthcare decisions and is not limited to resuscitation choices alone.

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The Do Not Intubate (DNI) order is another document that aligns with the principles of the DNR. A DNI order specifically indicates that a patient does not want to be placed on a ventilator if they are unable to breathe independently. Both documents reflect a patient’s wishes regarding life-sustaining interventions, but the DNI focuses solely on intubation, while the DNR addresses resuscitation efforts more broadly.

The Comfort Care Order is also relevant in this context. This document emphasizes providing comfort and palliative care rather than aggressive treatment measures. Like the DNR, the Comfort Care Order prioritizes the patient’s quality of life and can be used in conjunction with a DNR to ensure that the patient’s wishes for comfort are met without invasive interventions.

The Declaration for Mental Health Treatment is another document that bears resemblance to the DNR. This declaration allows individuals to express their preferences regarding mental health treatment in the event they become unable to make decisions. While the DNR focuses on physical health and resuscitation, both documents serve to uphold a person's autonomy and ensure that their treatment preferences are respected.

Lastly, the Do Not Hospitalize (DNH) order can be seen as similar to the DNR. A DNH order expresses a patient’s wish to avoid hospitalization, particularly in end-of-life scenarios. Both documents reflect the desire to minimize aggressive medical interventions and prioritize comfort, aligning with the overarching goal of respecting a patient’s wishes regarding their care.

Fill out More Do Not Resuscitate Order Forms for Different States

Can You Have a Dnr at Any Age - It is important for patients and families to discuss their wishes openly before filling out the DNR order.

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Misconceptions

Many people have misunderstandings about the Ohio Do Not Resuscitate (DNR) Order form. Here are five common misconceptions:

A DNR means I will not receive any medical care. This is not true. A DNR only indicates that you do not want to receive CPR in the event of cardiac arrest. You will still receive other necessary medical treatments.
Only terminally ill patients can have a DNR. This is a misconception. Anyone can request a DNR if they do not wish to be resuscitated, regardless of their health status.
A DNR is the same as a living will. While both documents relate to end-of-life decisions, they serve different purposes. A living will outlines your wishes regarding medical treatments in various situations, while a DNR specifically addresses resuscitation efforts.
I need a lawyer to create a DNR. This is not necessary. You can complete the Ohio DNR form on your own, as long as you follow the guidelines provided by the state.
Once I have a DNR, I can’t change my mind. This is incorrect. You can revoke or change your DNR order at any time, as long as you follow the proper procedures to do so.

Understanding these points can help clarify what a DNR order means for you and your healthcare decisions.

PDF Form Overview

Fact Name	Description
Purpose	The Ohio Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation efforts in case of cardiac or respiratory arrest.
Governing Law	The Ohio DNR Order is governed by Ohio Revised Code Section 2133.21 through 2133.27.
Eligibility	Any adult with decision-making capacity can complete a DNR Order. It can also be completed for minors with parental consent.
Signature Requirements	The form must be signed by the individual, or their legal representative, and must also be signed by a physician.
Effectiveness	Once properly completed and signed, the DNR Order is effective immediately and must be honored by healthcare providers.