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

Decisions around end-of-life care are deeply personal and often complex, reflecting a person’s values, beliefs, and wishes regarding how they want to be treated in their final moments. In Oklahoma, individuals have the opportunity to make these critical decisions known through the Oklahoma Do Not Resuscitate (DNR) Order form. This legal document allows residents to declare their wish not to receive cardiopulmonary resuscitation (CPR) in the event that their heart stops beating or they stop breathing. It is a predetermined decision made by the individual or their authorized representative, often after careful consideration and discussion with family and healthcare providers. The form is part of a broader set of advanced directives available within the state, aiming to respect the autonomy of patients and ensure that medical treatment aligns with their personal values and wishes. By completing this form, individuals can ensure that their healthcare preferences are documented and respected, potentially relieving their loved ones from making these difficult decisions under stress or in moments of crisis.

Example - Oklahoma Do Not Resuscitate Order Form

Oklahoma Do Not Resuscitate Order (DNR)

This document is prepared in accordance with the Oklahoma Do Not Resuscitate (DNR) Act, allowing certain individuals to refuse resuscitation measures in the event of cardiac or respiratory arrest. Please complete all sections to ensure the document is legally binding.

Patient Information

Patient Name: ________________________________________________

Address: _____________________________________________________

City: _______________________ State: OK Zip: _________

Date of Birth: _______________________________________________

Telephone Number: ____________________________________________

Medical Information

Primary Physician: ___________________________________________

Physician's Telephone Number: _________________________________

Medical Conditions: __________________________________________

DNR Order

Under the Oklahoma Do Not Resuscitate Act, I, the undersigned, being of sound mind and legal capacity, hereby direct that in the event my heart stops beating or I stop breathing, no resuscitative measures shall be initiated.

I understand that this order does not affect the provision of other emergency care, including treatment for pain, difficulty breathing, or other medical conditions not requiring resuscitation.

Signature

Patient or Legally Authorized Representative Signature: ____________________________

Date: ____________________________________

Witness Signature: ____________________________________________

Date: ____________________________________

Physician's Verification

I, the undersigned physician, affirm that I have discussed the nature and consequences of a Do Not Resuscitate (DNR) order with the patient or the patient's legally authorized representative. I affirm that the patient or their representative fully understands that this request means no attempt will be made to resuscitate the patient in the event of cardiac or respiratory arrest.

Physician's Signature: _________________________________________

Date: ____________________________________

Instructions for Use

This completed and signed document should be provided to all healthcare providers, including hospital staff and emergency medical services, to ensure it is followed. It is recommended that the patient or their representative discuss this document with their primary healthcare provider.

Keep this document in an easily accessible location and consider informing close family members or caregivers of its existence and location.

PDF Form Attributes

Fact Name Description
Purpose The Oklahoma Do Not Resuscitate (DNR) Order form is designed to inform medical personnel not to perform CPR (Cardiopulmonary Resuscitation) or other life-sustaining treatments on the patient who has this order in place.
Governing Law The form is governed under the Oklahoma Statutes Title 63, which covers public health and safety regulations, specifically addressing the patient's rights to refuse certain medical treatments.
Who Can Sign The DNR order can be signed by the patient themselves if they are of sound mind and at least 18 years old or by the patient’s legally authorized representative if the patient is unable to make their own medical decisions.
Validity The DNR order is valid across Oklahoma as soon as it's signed and dated by both the patient (or their representative) and the patient's physician, indicating that the decision is informed and consensual.
Revocation The DNR order can be revoked at any time by the patient or their authorized representative, either verbally or in writing, without needing any specific form or procedure.

Instructions on How to Fill Out Oklahoma Do Not Resuscitate Order

Filing a Do Not Resuscitate (DNR) Order in Oklahoma is a paramount decision that involves reflecting upon one's medical care preferences in critical situations. This form communicates a person's wish not to have cardiopulmonary resuscitation (CPR) in the event their heart stops or they stop breathing. It is crucial for ensuring that these wishes are respected by healthcare providers. Here are the steps needed to properly fill out the Oklahoma Do Not Resuscitate Order form to ensure that the person's medical care preferences are clearly communicated and legally recognized.

  1. Gather Required Information: You'll need the full name of the person the DNR Order is for, their date of birth, and their address. This helps in clearly identifying the individual to whom the DNR Order applies.
  2. Healthcare Provider Consultation: Discuss the decision with a healthcare provider. A DNR Order needs to be signed by a licensed healthcare provider to be valid. This ensures that the individual making the DNR request understands the medical implications of their decision.
  3. Completing the Form: Fill out the form with the patient's personal information, including their full name, date of birth, and complete address.
  4. Healthcare Provider's Information: The healthcare provider must include their name, signature, license number, and the date of signing. This certifies that they have discussed the DNR Order with the patient or their legal representative.
  5. Patient or Representative’s Signature: The patient, or their legally authorized representative if the patient is unable to sign, must sign and date the form. This provides a clear, written record of the patient's desires regarding CPR.
  6. Witness Signature: A witness must sign and date the form, attesting to the authenticity of the patient or representative’s signature. This adds an additional layer of verification to the process.
  7. Review and Confirm: Double-check all information for accuracy and completeness. Mistakes could potentially invalidate the document or cause confusion about the patient's wishes.
  8. Submit the Form: Follow the instructions provided by the healthcare provider for submitting the completed form. This often involves filing it with the healthcare provider and possibly a statewide registry, ensuring that the DNR order is accessible to healthcare professionals when needed.

It's important for individuals and their families to communicate openly about their decision to complete a DNR Order. Having this conversation ensures that all parties understand and respect the individual's wishes. Remember, a DNR Order can be revised or revoked by the individual at any time, provided they communicate their new wishes to their healthcare provider. Properly completing and submitting the DNR form is a critical step in ensuring an individual's healthcare preferences are honored during crucial moments.

Crucial Points on This Form

What is a Do Not Resuscitate Order in Oklahoma?

A Do Not Resuscitate (DNR) Order in Oklahoma is a legal document signed by a patient or their legal representative and a physician. It instructs healthcare providers not to perform CPR (Cardiopulmonary Resuscitation) or other life-sustaining treatments if the patient's heart stops or if they stop breathing. This decision is usually made by individuals with serious illnesses or those who wish to avoid aggressive medical interventions at the end of life.

How can one obtain a DNR Order in Oklahoma?

To obtain a DNR Order in Oklahoma, a conversation with a healthcare provider is necessary. The patient, or their legal representative, must discuss their wishes regarding end-of-life care with their physician. If a DNR Order is deemed appropriate, the patient, their representative, and the physician will need to complete and sign the Oklahoma DNR Order form. It's essential that the form is kept in an easily accessible location so it can be quickly presented to healthcare professionals when needed.

Is the DNR Order applicable outside of a hospital setting in Oklahoma?

Yes, in Oklahoma, the DNR Order is effective both in and out of hospital settings. This means that emergency medical services (EMS) personnel, such as paramedics and emergency medical technicians, are also required to respect the wishes outlined in a DNR Order if they are provided with the document during an emergency situation. This can include circumstances at the patient’s home, in assisted living facilities, or in other non-hospital environments.

Can a DNR Order be revoked or changed in Oklahoma?

Yes, a DNR Order can be revoked or changed at any time by the patient or their legal representative. To revoke the DNR Order, the patient or representative must inform the healthcare provider verbally or in writing. If written, a new form should be completed if the patient’s wishes regarding resuscitation have changed. All previous copies of the DNR Order should be destroyed to prevent confusion.

What should be done with the DNR Order once it is signed?

Once the DNR Order is signed, it should be kept in a location where it can be easily found during an emergency. It is advisable for patients to inform their family members, caregivers, and close friends about the DNR Order and its location. Some individuals choose to keep a copy with their personal documents, and others might place it on the refrigerator or in another prominent location. It’s also recommended to carry a wallet card indicating the existence of a DNR Order, especially when traveling outside the home.

Common mistakes

When filling out the Oklahoma Do Not Resuscitate (DNR) Order form, individuals often make key errors that can affect the efficacy and enforceability of the document. Recognizing and avoiding these mistakes is crucial to ensure that healthcare providers can follow the patient’s wishes regarding resuscitation. Below is an expanded list of common pitfalls:

  1. Not having the form signed by a physician: One of the most significant mistakes is failing to get the DNR order signed by a licensed physician. In Oklahoma, for a DNR order to be valid, it must have a doctor's signature. This validates the document, confirming that the patient's healthcare wishes were discussed and agreed upon medically.

  2. Incomplete patient information: Ensuring that all patient information is thoroughly and accurately filled out is critical. Missing details can lead to confusion or delays in emergency situations. This includes the patient's full name, date of birth, and other identifying information that healthcare providers can use to verify the patient's identity and DNR status.

  3. Forgetting to renew or update the form: A common oversight is not realizing that DNR orders may need to be reviewed and renewed. People’s healthcare preferences can change over time, as can their health conditions. Regularly reviewing and updating the DNR form ensures that it reflects the patient’s current wishes.

  4. Lack of copies and failure to notify key parties: After completing the form, another mistake is not making sufficient copies or failing to inform family members, healthcare proxies, or caregivers of the DNR order. It's important that copies are readily accessible and that those involved in the patient’s care are aware of the patient’s resuscitation preferences.

By avoiding these common mistakes, individuals can better safeguard their healthcare decisions and ensure their wishes are known and respected by medical personnel in critical situations.

Documents used along the form

When dealing with healthcare decisions, especially those as critical as end-of-life choices, one often encounters several important forms besides the Oklahoma Do Not Resuscitate (DNR) Order. These documents are crucial in ensuring that an individual's healthcare wishes are respected and legally recognized. They provide a clear guide for family members and healthcare providers, thereby reducing confusion and distress during challenging times. Here is a comprehensive list of such documents often used in conjunction with the Oklahoma DNR Order:

  • Advance Directive for Health Care: This document allows individuals to state their preferences for medical treatment in case they become unable to make decisions for themselves. It can include decisions about life support and specifies what, if any, extraordinary measures should be taken.
  • Medical Power of Attorney (Healthcare Proxy): This form designates a person, known as a healthcare proxy, to make healthcare decisions on behalf of an individual, should they become incapacitated. This person's authority can cover a broad range of medical decisions, not just those concerning life-sustaining treatment.
  • Living Will: Similar to an Advance Directive, a Living Will specifically outlines which treatments an individual does or does not want if they're facing a terminal illness or are near death. It can serve as a guide for doctors and caretakers in end-of-life care situations.
  • Physician Orders for Life-Sustaining Treatment (POLST): A POLST form complements a DNR order by providing more detailed instructions about other types of life-sustaining treatments beyond CPR, such as mechanical ventilation or feeding tubes. It is designed to ensure that patients' wishes are followed by all healthcare providers across settings.
  • Out-of-Hospital Do Not Resuscitate Order: This is similar to the regular DNR but is specifically for use outside of hospital settings, such as in ambulances, by emergency medical technicians, or in outpatient care environments.
  • Health Information Authorization (HIPAA Release Form): This form grants permission for healthcare providers to share an individual’s health information with specified people, such as family members or other doctors. It is crucial for coordination of care and ensuring that proxies have the information they need to make informed decisions.
  • Organ and Tissue Donation Form: This document allows individuals to specify their wishes regarding organ and tissue donation at the time of death. It is important for those who want to make this life-saving gift to others.
  • Emergency Contact Form: While not legally binding, having an emergency contact form can ensure that healthcare providers know whom to contact in a critical situation. It can provide peace of mind that loved ones will be notified promptly.
  • Last Will and Testament: Although not directly related to healthcare decisions, a Last Will and Testament can designate the distribution of an individual's assets posthumously and can include funeral wishes. Ensuring this document is in place can alleviate additional stress on family members during a difficult time.

Together, these documents empower individuals to have a say in their healthcare and end-of-life decisions. It's advisable for everyone, regardless of their health status, to consider these forms thoughtfully. Making such decisions known in advance can greatly ease the burden on family members and ensure that healthcare wishes are honored. Legal professionals can offer guidance in preparing these documents to ensure they meet all legal requirements and accurately reflect an individual's wishes.

Similar forms

  • Living Will: A Living Will is a document that outlines a person's wishes regarding medical treatment in situations where they can no longer express informed consent. Similar to a Do Not Resuscitate (DNR) Order, it serves to communicate the individual's preferences for end-of-life care, but it covers a broader range of medical decisions beyond the scope of cardiopulmonary resuscitation (CPR).

  • Healthcare Power of Attorney (POA): This legal document allows an individual to appoint someone else to make medical decisions on their behalf if they are unable to do so. Like a DNR Order, it activates under specific medical conditions. However, the scope of a Healthcare POA is broader, empowering the designated agent to make a wide range of health care decisions, not just regarding resuscitation.

  • Five Wishes: Five Wishes is a comprehensive document that blends elements of a living will and health care power of attorney. It addresses personal, spiritual, and medical desires at the end of life. It resembles a DNR Order in its function to guide medical care based on the patient's wishes when they cannot communicate, especially concerning life-support treatment and conditions under which the patient would want to decline or receive certain types of medical interventions.

  • POLST (Physician Orders for Life-Sustaining Treatment): POLST is a medical order for the seriously ill or frail, detailing what types of medical treatment patients wish to receive towards the end of life. Like a DNR, a POLST makes specific medical orders directly actionable by healthcare providers, including whether or not to attempt resuscitation. However, POLST goes beyond the DNR by addressing a broader range of life-sustaining treatments, such as feeding tubes or antibiotics.

Dos and Don'ts

Filling out the Oklahoma Do Not Resuscitate (DNR) Order form is an important process that requires attention to detail and specificity. Ensuring the form is completed correctly is vital for the wishes of the individual to be honored. Below are lists of things you should and shouldn't do when completing this form.

Things you should do:

  1. Double-check the patient's information: Make sure all personal information, including full name, date of birth, and address, is accurate and clearly legible.
  2. Consult with a healthcare provider: Before completing the form, it's important to discuss the implications of a DNR order with a doctor to fully understand the medical and ethical considerations.
  3. Ensure proper signatures are obtained: The form must be signed by the appropriate parties, which typically include the patient (or their legal healthcare proxy) and the attending physician. Verify that all required signatures are present.
  4. Keep the DNR order accessible: Once the form is filled out and duly signed, it should be kept in an easily accessible place so that it can be presented to healthcare providers when needed.
  5. Inform family members or caregivers: It is wise to inform close family members or caregivers about the existence of the DNR order so they can advocate on the patient's behalf and ensure the document is respected.

Things you shouldn't do:

  1. Leave sections incomplete: Do not leave any sections of the form blank. If a section does not apply, indicate with "N/A" (not applicable) rather than leaving it empty.
  2. Use ambiguous language: Avoid using terms or phrases that can be interpreted in multiple ways. The language in the form should be clear and precise to prevent any misinterpretation.
  3. Rely solely on verbal instructions: While discussing wishes regarding resuscitation is crucial, verbal instructions alone may not be legally binding. The DNR order must be documented and signed on the official form.
  4. Alter the form after completion: Once the form is completed and signed, it should not be altered. Any changes or corrections should be addressed by completing a new form to avoid confusion or disputes.
  5. Forget to review and update regularly: Medical preferences and conditions may change over time. It's important to review the DNR order periodically and update it as necessary to reflect current wishes.

Misconceptions

When it comes to understanding medical and legal forms, misconceptions abound. The Oklahoma Do Not Resuscitate (DNR) Order is no exception, with numerous false beliefs circulating about its purpose and effects. Here, we clear up some of the most common misunderstandings.

  • "Signing a DNR means you'll be denied emergency services." This is a prevalent myth. In reality, a DNR only instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. You will still receive all other appropriate medical treatments and interventions, including pain management and emergency services, that do not involve CPR.
  • "The DNR form is permanent and irrevocable." This is not the case. In Oklahoma, as in many other states, the DNR order can be revoked at any time by the patient or their legally authorized representative. This revocation can be done verbally or by physically destroying the DNR form. It’s important to communicate your wishes clearly with your healthcare providers and loved ones.
  • "A DNR order is only for the elderly or those with terminal illnesses." This misconception overlooks the diverse circumstances in which individuals might consider a DNR. While it is often associated with terminal illness or advanced age, any person who wishes to avoid CPR for personal or medical reasons can choose to have a DNR, irrespective of age or health condition.
  • "You need a lawyer to complete a DNR order." While legal documentation can be daunting, the process for completing a DNR in Oklahoma does not require legal assistance. The form must be signed by the individual or their legal representative and a physician or advanced practitioner. However, discussing your end-of-life wishes with a legal advisor can be beneficial as part of broader estate and healthcare planning.
  • "If I have a DNR, my wishes might be ignored if I’m in a different state." While it's true that states have their own DNR forms and regulations, most healthcare professionals across the United States respect the wishes expressed in out-of-state DNR orders, especially when they are presented with documentation. It’s advisable to have a discussion with your healthcare provider if you travel or live between states to understand how best to ensure your wishes are followed.

Understanding the specifics of the Oklahoma Do Not Resuscitate Order can help ensure that your healthcare wishes are respected. Clearing up these misconceptions is an essential step in making informed decisions about your health and well-being.

Key takeaways

Understanding how to properly fill out and use the Oklahoma Do Not Resuscitate (DNR) Order form is crucial for ensuring a person's wishes regarding life-saving measures are respected. Below are key takeaways to guide individuals and their families through the process:

  • Eligibility: A DNR order is intended for patients with serious illnesses or at the end of life who wish to decline resuscitation efforts in the event of cardiac or respiratory arrest.
  • Consultation with a Healthcare Provider: Before completing a DNR form, it's important to discuss the decision with a healthcare provider to understand the implications fully.
  • Completing the Form: The DNR form must be filled out accurately, including the patient's full name, date of birth, and specific medical orders. Inaccuracies can lead to confusion or the form being invalidated.
  • Signature Requirements: The form requires signatures from the patient or their legally authorized representative, as well as the attending physician, to be valid.
  • Accessibility: Once completed and signed, the DNR order should be kept in a visible and accessible location. In an emergency, healthcare providers need to locate and reference the form quickly.
  • Inform Family Members and Caregivers: It's important to discuss the existence of a DNR order with family members and any caregivers to ensure they understand the patient's wishes.
  • Copies: Make several copies of the completed DNR order. Keep a copy at home, and provide copies to family members and healthcare providers involved in the patient's care.
  • Review and Update: Regularly review the DNR order to ensure it still reflects the patient's wishes, especially after any significant changes in the patient's health condition. The form can be revoked or revised at the patient's discretion.
  • Legality Across Settings: The Oklahoma DNR order is recognized and respected across different settings, including hospitals, nursing homes, and in the patient's own home.
  • Revocation: A DNR order can be revoked by the patient or their authorized representative at any time. This can be done either verbally or by physically destroying the DNR form.

Following these guidelines ensures that the patient's wishes regarding resuscitation are clearly communicated and respected by everyone involved in their care. It's a meaningful step toward honoring a person's healthcare preferences during critical moments.

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