Free Do Not Resuscitate Order Form for Illinois
Article Map
Preview - Illinois Do Not Resuscitate Order Form
Illinois Do Not Resuscitate Order
This document serves as a legally binding Do Not Resuscitate (DNR) order in accordance with Illinois law. It allows the signer to indicate their wishes concerning resuscitative measures in the event of a medical emergency.
Patient Information:
- Patient Name: ______________________
- Date of Birth: ______________________
- Address: ____________________________
- City, State, Zip: ___________________
Authorized Person:
- Name: ______________________________
- Relationship to Patient: ______________
- Contact Number: ______________________
This order states that the patient does not wish to receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures in the event of cardiac or respiratory arrest. The effectiveness of this order is contingent upon clear communication to medical personnel.
Signature:
- Patient's Signature: ___________________
- Date: ________________________________
If signed by a representative, please fill out the following:
- Representative's Signature: ____________
- Relationship to Patient: ______________
- Date: ________________________________
This DNR order will be honored by emergency medical services in Illinois. It is recommended to keep a copy of this order in an accessible location and inform family members and healthcare providers about its existence.
Create Other Common Do Not Resuscitate Order Forms for Different States
Is a Dnr an Advance Directive - A DNR does not prevent comfort measures like pain relief from being provided.
An Operating Agreement is a vital document that outlines the management structure and operating procedures for a limited liability company (LLC). It serves as an internal guide for members, detailing financial arrangements, voting rights, and responsibilities. To ensure compliance and clarity, consider filling out the form by clicking the button below: https://pdftemplates.info/operating-agreement-form.
Dnr Paperwork - This document is a way for patients to take charge of their healthcare journey.
Similar forms
- Advance Directive: This document outlines a person's preferences for medical treatment in situations where they may be unable to communicate. Like a DNR, it guides healthcare providers in making decisions aligned with the patient's wishes.
- Living Will: A living will specifies what types of medical treatment a person does or does not want if they become terminally ill or incapacitated. It serves a similar purpose to a DNR by expressing the individual's desires regarding end-of-life care.
- Power of Attorney for Healthcare: This document designates someone to make healthcare decisions on behalf of an individual if they are unable to do so. It complements a DNR by ensuring that someone trusted can advocate for the patient's wishes.
- Physician Orders for Life-Sustaining Treatment (POLST): POLST forms provide specific medical orders based on a patient's preferences regarding life-sustaining treatments. Like a DNR, it is intended for patients with serious illnesses and is honored by healthcare providers.
- Trailer Bill of Sale: This essential document facilitates the transfer of ownership of a trailer in Louisiana and ensures legal recognition of the transaction. For comprehensive details and to complete your transaction, refer to the Motor Vehicle Bill of Sale.
- Do Not Intubate Order: This order specifically instructs medical personnel not to insert a breathing tube in the event of respiratory failure. It is similar to a DNR as both documents focus on limiting aggressive medical interventions.
- Comfort Care Order: This document emphasizes the provision of comfort measures rather than curative treatments. It aligns with the principles of a DNR by prioritizing quality of life over aggressive medical interventions.
- Healthcare Proxy: A healthcare proxy allows an individual to appoint someone to make medical decisions on their behalf. This document can work alongside a DNR to ensure that the appointed person understands and respects the patient's wishes.
- End-of-Life Care Plan: This comprehensive plan outlines a person's preferences for care as they approach the end of life. It may include elements of a DNR, ensuring that all aspects of care align with the patient's values and desires.