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Preview - Georgia Do Not Resuscitate Order Form
Georgia Do Not Resuscitate Order Template
This Do Not Resuscitate (DNR) Order, compliant with Georgia state law, is a formal declaration by the undersigned, regarding medical treatment preferences in the event of a medical emergency.
By completing this document, you are expressing your wishes regarding resuscitation in the event of cardiac or respiratory arrest. This order must be honored by healthcare providers in the state of Georgia.
Patient Information:
- Patient Name: _________________________________
- Date of Birth: _________________________________
- Address: ____________________________________
- Phone Number: _______________________________
Advance Directive Declaration:
I, the undersigned, declare that under no circumstances do I wish to receive cardiopulmonary resuscitation (CPR) or any other life-sustaining treatment in the event of my heart stopping or if I am no longer breathing. I understand that by signing this document, I am refusing resuscitative measures.
Signatures:
- Patient Signature: ___________________________
- Date: ______________________________________
- Witness Signature: _________________________
- Date: ______________________________________
This document must be presented to healthcare providers to ensure that my wishes are respected. It is recommended to keep a copy with your healthcare proxy, in your medical records, and at home.
The laws regarding Do Not Resuscitate Orders may vary, so it is wise to consult with a healthcare professional or legal advisor to ensure your document is valid and complete.
Create Other Common Do Not Resuscitate Order Forms for Different States
Polst Form Illinois - A DNR can help avoid unwanted procedures that would not benefit a terminally ill patient.
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Dnr Paperwork - This document allows individuals to express their end-of-life care preferences clearly.
Similar forms
- Living Will: This document outlines a person's wishes regarding medical treatment in situations where they cannot communicate. Like a DNR, it focuses on end-of-life care decisions.
- Healthcare Proxy: A healthcare proxy appoints someone to make medical decisions on your behalf. This document works alongside a DNR, ensuring that your wishes are respected.
- Advance Directive: An advance directive combines elements of a living will and healthcare proxy. It provides comprehensive instructions about your healthcare preferences, including resuscitation wishes.
- Power of Attorney for Healthcare: This document grants authority to a designated individual to make healthcare decisions. It is similar to a healthcare proxy but can cover a broader range of decisions.
- POLST (Physician Orders for Life-Sustaining Treatment): A POLST form translates a patient's treatment preferences into medical orders. It is more detailed than a DNR and is designed for those with serious illnesses.
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- Do Not Intubate (DNI) Order: This order specifies that a patient should not be placed on a ventilator. It is similar to a DNR, focusing on specific interventions rather than resuscitation as a whole.
- Cardiac Arrest Protocol: This protocol outlines the steps to take in the event of a cardiac arrest. It may include DNR instructions, ensuring that medical personnel are aware of the patient's wishes.