Homepage Legal Do Not Resuscitate Order Form Blank Do Not Resuscitate Order Form for Georgia
Content Overview

The Georgia Do Not Resuscitate (DNR) Order form is a crucial document for those wishing to make clear their preferences regarding resuscitation in the event of a life-threatening situation. This form, recognized and honored across Georgia, effectively communicates an individual's desire not to receive CPR (Cardiopulmonary Resuscitation) or advanced cardiac life support if their breathing stops or if their heart stops beating. The decision to complete a DNR form is deeply personal and usually comes after thoughtful consultation with healthcare providers, family, and sometimes legal counsel. It's essential for individuals and their loved ones to understand the form's significance, the specific circumstances under which it applies, and the steps required to ensure it is properly executed and accessible when needed. With this knowledge, those facing serious illnesses or life-threatening conditions can make informed decisions that align with their wishes and healthcare goals.

Example - Georgia Do Not Resuscitate Order Form

Georgia Do Not Resuscitate Order (DNR)

This document serves as a Do Not Resuscitate Order (DNR) in accordance with the Georgia Do Not Resuscitate Act. It indicates the explicit request of the undersigned patient or their legally authorized representative that no resuscitation should be attempted in the event of the patient's cardiac or respiratory arrest. This document is legally binding and must be adhered to by healthcare providers and emergency personnel under the laws of the State of Georgia.

Patient Information

Patient's Full Name: ___________________________________________________

Date of Birth: _________________________________________________________

Address: ______________________________________________________________

City: ___________________________ State: GA Zip Code: _______________

Medical Information

Primary Physician's Name: ________________________________________________

Primary Physician's Contact Number: ______________________________________

Do Not Resuscitate Consent

The undersigned hereby consents to the Do Not Resuscitate order and understands that in the event of a cardiac or respiratory arrest, resuscitative measures shall not be initiated. The following are authorized to sign:

  1. The patient, if of sound mind and 18 years of age or older.
  2. A legally authorized representative, if the patient is a minor or deemed incompetent.

Signature: ____________________________________________ Date: _________________

If signed by a legally authorized representative, full name: ___________________________

Relationship to Patient: _____________________________________________________

Physician's Verification

This section must be completed by a licensed physician, who verifies the patient's condition and the appropriateness of the Do Not Resuscitate Order in accordance with the patient's medical condition and wishes.

Physician's Signature: ___________________________________ Date: _________________

Physician's Printed Name: ________________________________________________________

Medical License Number: _________________________________________________________

Additional Notes

This Do Not Resuscitate Order is valid throughout the State of Georgia. It is recommended that this document be reviewed regularly and kept in a place where it is easily accessible to family members and healthcare providers. If the patient wishes to rescind this order at any time, it is their responsibility to inform their healthcare provider immediately.

PDF Form Attributes

Fact Detail
Purpose The Georgia Do Not Resuscitate (DNR) Order form is designed to inform healthcare professionals not to perform cardiopulmonary resuscitation (CPR) on the patient in case of a cardiac or respiratory arrest.
Governing Law It is governed by Georgia’s Advance Directive for Health Care Act, which ensures that individuals have the right to make decisions regarding their own health care, including the refusal of resuscitation.
Validity Requirements To be valid, the form must be properly completed and signed by both the patient (or their legally authorized representative) and the attending physician. It must also clearly state the patient's wish not to receive CPR.
Application The form is applied in settings where medical professionals are called to provide emergency treatment, including hospitals, nursing homes, and during emergency medical services (EMS) operations.

Instructions on How to Fill Out Georgia Do Not Resuscitate Order

Filling out a Georgia Do Not Resuscitate (DNR) Order form is an important step for individuals who want to make clear their wishes about not receiving CPR (cardiopulmonary resuscitation) in case their heart stops or they stop breathing. This form is a crucial document that communicates your decisions to healthcare providers. The process of completing it is straightforward but must be approached with care to ensure that it accurately reflects your wishes.

  1. Begin by reading the entire form carefully to understand the implications of a DNR order and ensure that this decision aligns with your healthcare objectives.
  2. Enter your full legal name to identify yourself as the person to whom the DNR order applies.
  3. Print your date of birth in the designated space to provide verification of your identity.
  4. Provide your address in the specified sections for additional identification purposes. This includes your street address, city, state, and zip code.
  5. If the form requires it, include a recent photograph to help healthcare providers easily identify you. Ensure that this photo is attached securely and meets any specified requirements.
  6. Read the section that describes the conditions under which the DNR order applies. This is crucial for understanding when healthcare providers will refer to this document.
  7. Sign and date the form in the presence of the required witnesses. Your signature is necessary to validate your consent to the DNR order. Ensure the date is current and clearly legible.
  8. Have the required witnesses sign the form. Their signatures confirm that you signed the document voluntarily and without any form of coercion.
  9. If applicable, ensure that your physician signs the form as well. A physician's signature might be needed to authenticate the order and confirm your medical condition warrants a DNR.
  10. Keep the original form in a place where it can be easily found by family members or emergency responders, such as attached to the refrigerator or in an easily accessible file. Inform family members, healthcare providers, and caregivers of its location.

After completing the Georgia DNR order form, it's crucial to communicate your decision to family, friends, and all healthcare providers involved in your care. Ensuring everyone understands your wishes can alleviate stress and confusion in emergency situations. Remember, a DNR order can be revoked at any time by destroying the document or creating a new medical directive. Discussing your decision with your healthcare provider can also provide clarity and ensure that your healthcare plan aligns with your wishes.

Crucial Points on This Form

What is a Do Not Resuscitate (DNR) Order in Georgia?

A Do Not Resuscitate (DNR) Order in Georgia is a medical order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating. This decision is often made by a patient, sometimes in consultation with their family and healthcare providers, especially if the patient is suffering from a terminal illness or is in a condition where resuscitation would not improve their quality of life.

Who can request a DNR Order in Georgia?

In Georgia, a DNR Order can be requested by any adult patient who is of sound mind, or by the patient's legally authorized representative, if the patient is unable to make their own healthcare decisions. This includes the appointment of a healthcare agent through a durable power of attorney for healthcare.

How can one obtain a DNR Order in Georgia?

A DNR Order in Georgia must be obtained through a conversation with a healthcare provider. This provider will assess the patient's condition and discuss the potential outcomes and implications of a DNR Order. If it is determined to be in the patient's best interest, the healthcare provider will prepare the DNR Order, ensuring it complies with Georgia’s legal requirements.

Is the Georgia DNR Order form available online?

While specific DNR Order forms for Georgia may be available through healthcare providers or legal resources, the official form is not typically available for download online due to the need for a healthcare provider's assessment and signature. Individuals interested in a DNR Order should consult with their healthcare provider directly.

Can a DNR Order be revoked?

Yes, in Georgia, a DNR Order can be revoked at any time by the patient or their legally authorized representative. This can be done verbally or in writing. It is crucial to communicate the revocation to the healthcare provider to ensure the DNR Order is removed from the patient’s medical record.

Does a DNR Order affect the provision of other treatments?

No, a DNR Order specifically refers to the non-performance of CPR in cases of cardiac or respiratory arrest. It does not impact the provision of other medical treatments, such as pain management, oxygen, or the administration of medications. The intent is to allow natural death in dignity rather than to refuse all medical interventions.

Is a DNR Order valid in all healthcare settings within Georgia?

A DNR Order is generally recognized across different healthcare settings within Georgia, including hospitals, nursing homes, and in-home care situations. However, it is advisable to inform all healthcare providers involved in the patient’s care of the existence of a DNR Order to ensure it is respected in all settings.

Do emergency medical services (EMS) honor a DNR Order in Georgia?

Yes, emergency medical services in Georgia are required to honor a valid DNR Order when presented. It is helpful for the patient or their caregivers to keep a copy of the DNR Order readily accessible in case of an emergency. Discussing the DNR Order with EMS providers in advance, if possible, can also facilitate its implementation.

What is the difference between a DNR Order and a living will in Georgia?

A DNR Order and a living will are both advance directives in Georgia, but they serve different purposes. A DNR Order is specifically related to the non-performance of CPR, while a living will provide broader instructions regarding a person’s preferences for various types of medical treatment in the event they are unable to communicate their wishes directly. Many individuals choose to have both documents in place to ensure their healthcare preferences are fully documented and respected.

How does one ensure that their DNR Order is effectively implemented?

To ensure a DNR Order is effectively implemented in Georgia, patients should keep copies in an easily accessible location and inform their family, healthcare agent, and all healthcare providers of their decision. Wearing a DNR bracelet or carrying a wallet card that indicates the existence of a DNR Order can also help notify emergency personnel of the patient’s wishes quickly.

Common mistakes

Filling out a Georgia Do Not Resuscitate (DNR) Order form is a critical step for those who want to clearly communicate their wishes regarding life-saving treatment. However, it's crucial to approach this document with care to ensure that it accurately reflects your intentions. Avoiding common mistakes can mitigate any future complications or misunderstandings. Here are five key errors people often make:

  1. Not consulting with a healthcare provider: Before completing a DNR form, it's important to discuss your health status and options with a medical professional. This conversation ensures that your decision is informed and based on a clear understanding of your medical condition.

  2. Incorrectly filling out personal information: Errors in personal details, such as misspelling your name or providing an incorrect date of birth, can lead to confusion and delay the implementation of your DNR order. Double-check these entries to avoid such issues.

  3. Failing to update the DNR order: Health circumstances and personal preferences can change over time. An outdated DNR form might not reflect your current wishes, making regular reviews and updates necessary.

  4. Not discussing the decision with family or loved ones: While the decision is ultimately yours, failing to communicate your wishes with those close to you can lead to distress and confusion in emergency situations. A clear discussion about your decision can help ensure that they understand and respect your wishes.

  5. Improperly signing or notarizing the form, if required: Each state has its own rules regarding the execution of DNR orders. In Georgia, ensuring that your form is signed correctly and meets any notarization requirements is crucial for its validity.

By addressing these common pitfalls, individuals can better safeguard their preferences regarding life-sustaining treatment. Always remember the importance of clear communication and accuracy when completing a Georgia DNR form.

Documents used along the form

In addition to the Georgia Do Not Resuscitate (DNR) Order Form, there are several other documents that are critically important for ensuring a person’s healthcare wishes are respected, especially during emergency situations or at the end of life. These documents complement the DNR by covering a broader array of circumstances and preferences regarding medical treatment and decision-making. Understanding each of these documents can help individuals and their loved ones prepare for various healthcare situations with clarity and confidence.

  • Advance Directive for Health Care: This document allows individuals to outline their healthcare preferences, including end-of-life care, and appoint a healthcare agent. This agent is empowered to make healthcare decisions on their behalf if they are unable to do so.
  • Medical Power of Attorney: Similar to part of the Advance Directive, this document specifically grants a designated agent the authority to make healthcare decisions on behalf of the individual, should they become incapacitated.
  • Living Will: A living will specifies an individual’s preferences regarding certain medical treatments and life-sustaining measures in cases of terminal illness or permanent unconsciousness where recovery is not expected.
  • POLST (Physician Orders for Life-Sustaining Treatment): This form goes beyond a Do Not Resuscitate order by providing detailed medical orders about the types of life-sustaining treatments an individual wants or does not want at the end of life. It is designed to be easily understandable by all healthcare providers.
  • HIPAA Release Form: This form authorizes healthcare providers to share an individual’s health information with designated people. It is crucial for family members or healthcare agents to have access to medical information to make informed decisions on the individual’s behalf.

Each of these documents serves a crucial role in healthcare planning, ensuring that individuals receive the care that aligns with their values and wishes. It is advisable for anyone considering a Georgia DNR to also explore these additional documents. Together, they provide a comprehensive approach to healthcare decision-making and end-of-life planning. It's important to review and update these documents regularly to ensure they accurately reflect one's current wishes.

Similar forms

  • Living Will: Like a Do Not Resuscitate (DNR) order, a Living Will is a document that outlines an individual's wishes regarding medical treatment in the event they become unable to communicate them. Both documents are designed to guide healthcare providers and loved ones in making decisions that align with the individual's preferences, especially regarding end-of-life care.

  • Healthcare Power of Attorney (HCPA): Similar to a DNR, a Healthcare Power of Attorney allows an individual to designate someone else (a healthcare agent) to make medical decisions on their behalf if they become incapacitated. While a DNR focuses specifically on the wish not to be resuscitated, an HCPA covers a broader range of medical decisions.

  • Advance Directive: An Advance Directive is akin to a DNR in that it is a document that specifies what actions should be taken for an individual's health if they are no longer able to make decisions due to illness or incapacity. It can include both a Living Will and a Healthcare Power of Attorney, thus encompassing the specific intentions of a DNR within a more comprehensive framework.

  • Medical Orders for Life-Sustaining Treatment (MOLST): Similar to a DNR, a MOLST provides specific instructions related to the provision of life-sustaining treatments, including resuscitation. Used by individuals facing serious health conditions, MOLST forms ensure that healthcare providers understand the patient's wishes concerning various life-sustaining measures, not just resuscitation.

  • Physician Orders for Life-Sustaining Treatment (POLST): Much like a DNR, a POLST form is designed for individuals with serious illnesses and specifies the types of medical treatment that a patient wishes to receive towards the end of life, including whether or not to attempt resuscitation. It goes beyond a DNR by addressing other treatments that a person does or does not want.

  • Emergency Medical Services (EMS) DNR: An EMS DNR is a specific type of DNR order intended for first responders and Emergency Medical Services. Like a hospital-issued DNR, it tells healthcare professionals not to perform CPR on the patient. However, it is specifically designed for use outside the hospital, typically in the patient's home.

  • Five Wishes Document: Though more expansive, Five Wishes is similar to a DNR as it is a type of advance directive that addresses personal, spiritual, and medical desires at the end of life. This document goes beyond medical instructions to include the individual's wishes on how they want to be treated and comforted, who they want by their side, and what they want their loved ones to know.

Dos and Don'ts

When filling out the Georgia Do Not Resuscitate (DNR) Order form, certain guidelines should be strictly followed to ensure the document is valid and effective. Below are the things that one should do and should not do when completing this important form.

Things You Should Do:

  1. Verify the patient's identity to ensure that the DNR order corresponds to the correct individual.
  2. Have the form signed by a licensed physician, as this is a requirement for the DNR order to be legally binding in Georgia.
  3. Discuss the decision thoroughly with the patient or, if applicable, the patient's legally authorized representative to ensure that the choice reflects the patient's wishes.
  4. Provide clear copies of the completed and signed DNR order to the patient, their family, and any healthcare facilities involved in the patient's care.

Things You Shouldn't Do:

  1. Don't fill out the form without consulting a healthcare provider to understand fully the implications and alternatives to a DNR order.
  2. Avoid leaving any section of the form blank. Incomplete forms may not be honored in a medical emergency.
  3. Never forge signatures or falsify information on the DNR form, as this can lead to legal consequences and invalidate the document.
  4. Do not fail to review and update the DNR order as necessary. Circumstances and decisions may change, so it's important that the DNR order reflects the current wishes of the patient.

Misconceptions

In discussions about health care and end-of-life preferences, the topic of Do Not Resuscitate (DNR) orders often emerges surrounded by misconceptions and inaccuracies, especially in the context of Georgia's DNR order form. Here's a detailed look at some of these misconceptions to shed light on the actual facts:

  • Signing a DNR is mandatory for elderly patients. This is not true. A Do Not Resuscitate (DNR) order is completely voluntary. The decision to sign one is a highly personal choice that depends on an individual's health conditions, values, and end-of-life preferences, regardless of age.

  • A DNR affects all medical treatments. Many people mistakenly believe that a DNR order restricts all forms of medical intervention. In reality, a DNR specifically applies to CPR (cardiopulmonary resuscitation) in the event of cardiac or respiratory arrest. It does not preclude the individual from receiving other types of medical care or treatments aimed at comfort and symptom management.

  • Once signed, a DNR cannot be changed. Another common misconception is that a DNR is irrevocable. However, a DNR order can be revoked or altered at any time by the patient or their legally authorized representative, reflecting the patient's current wishes and medical situation.

  • Only the patient can request a DNR order. While the decision to have a DNR order should be patient-centered, in instances where the patient is unable to make their own healthcare decisions, a legally authorized representative, such as a healthcare proxy or durable power of attorney for healthcare, can request a DNR order on behalf of the patient based on previously expressed wishes of the patient or the best interest of the patient.

  • DNR orders are only for the terminally ill. This is inaccurate. A DNR order may be considered by individuals with various health conditions, not just those who are terminally ill. The choice to have a DNR order is based on personal values, medical advice, and quality of life considerations.

  • Doctors can override a DNR if they disagree with it. In Georgia, healthcare providers are bound to respect legally completed DNR orders unless they believe it was not validly issued or if communicating with the patient or their legal representative leads to a revocation or modification of the order. Physicians cannot unilaterally override a patient's DNR order based on personal or professional disagreement with the order.

  • A DNR order is effective in any setting. While this is partly true in Georgia, the specifics can vary. For example, a DNR order is valid in hospitals and nursing homes. However, when emergency medical services (EMS) are called to a residence or public place, the DNR needs to be readily available and presented to the EMS personnel to be honored. Therefore, it's essential for individuals with a DNR order to ensure it is accessible in an emergency.

  • DNR orders and living wills are the same. This misconception fails to recognize the significant differences between these two documents. A DNR order is a specific medical order not to perform CPR. In contrast, a living will is a broader legal document that outlines a person's wishes regarding various types of medical treatments and interventions in scenarios other than just cardiac or respiratory arrest.

Key takeaways

Completing and utilizing the Georgia Do Not Resuscitate (DNR) Order form is an important process for those who wish to make clear their desires regarding life-saving measures in the event of a critical health emergency. Understanding the key aspects of this process can ensure that the wishes of the individual are respected and followed. Below are four key takeaways about filling out and using the Georgia DNR form.

  • Consultation with a Healthcare Provider is Essential: The first step in the process involves a thorough discussion with a healthcare provider. This is crucial as it ensures that the individual fully understands the implications of a DNR order and how it affects emergency medical treatment. The healthcare provider must confirm that the patient fully understands their choice and the consequences of a DNR order.
  • Proper Completion and Signatures: For a DNR order to be valid in Georgia, it must be properly filled out and signed. This includes the signature of the individual (or legally authorized representative if the individual is unable to sign) and the attending physician. The form requires clear information about the patient and a declaration of their wish not to receive cardiopulmonary resuscitation (CPR).
  • Visibility of the DNR Order: Once completed and signed, the DNR order must be kept in a place where it can be easily found by emergency personnel. For some, this might mean a prominently displayed location in the home or a designation on a medical alert bracelet. The quicker emergency responders can verify the existence of a DNR order, the more likely they are to comply with it during an emergency.
  • Review and Reaffirmation: Circumstances and perspectives can change. Therefore, it’s recommended that the DNR order be reviewed periodically. This ensures that it still reflects the individual’s current wishes. Any changes in health status or in decision-making capacity may necessitate a review and possibly a revision of the DNR order. Communication with family members and healthcare providers about the presence of a DNR and any changes to it is also crucial.
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