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Preview - Michigan Do Not Resuscitate Order Form
Michigan Do Not Resuscitate Order Template
This Do Not Resuscitate (DNR) Order is created in accordance with the Michigan Compiled Laws, specifically Section 333.1053. The purpose of this document is to ensure an individual's wishes regarding resuscitation efforts are respected during a medical emergency.
Patient Information:
- Full Name: ____________________________
- Date of Birth: ________________________
- Address: ______________________________
- City: _________________________________
- State: Michigan
- Zip Code: ____________________________
Living Will Statements:
By signing this document, I, ____________________________ (Patient Name), hereby declare the following:
- I do not wish to receive cardiopulmonary resuscitation (CPR) or other life-sustaining treatment if I am found to be in a state of cardiac arrest.
- This order applies only in situations where I have been determined to have no pulse and no respiration.
Additional Instructions (if any):
______________________________________________________
______________________________________________________
Patient Signature: ____________________________
Date: ______________________________________
Witness Information:
- Full Name: ____________________________
- Signature: ____________________________
- Date: ________________________________
This document needs to be presented to medical personnel at the time of an emergency. Please inform relevant family members of this order to ensure your wishes are known and respected.
Create Other Common Do Not Resuscitate Order Forms for Different States
Polst Form Illinois - A DNR does not impact other decisions, like organ donation or healthcare proxies.
Obtaining a Motor Vehicle Bill of Sale is essential for anyone engaged in a vehicle transaction, as it provides both parties with a clear record of the sale and helps facilitate the transfer of ownership in compliance with state regulations.
Dnr Hospital - A Do Not Resuscitate Order can be revoked by the patient at any time, based on their evolving wishes.
Out of Hospital Dnr Texas - The form should be clear and easily understood by medical staff to prevent miscommunication.
Do Not Resuscitate Form Georgia - This form can be especially important for those with terminal illnesses or severe, irreversible conditions.
Similar forms
- Advance Directive: This document outlines a person's preferences for medical treatment in situations where they cannot communicate their wishes. Like a DNR, it provides guidance to healthcare providers about the individual's desires regarding life-sustaining measures.
- Rental Application Form: Completing a pdftemplates.info/rental-application-form is crucial for prospective tenants to indicate their interest in a rental property, providing landlords essential insights into their background and financial status.
- Living Will: A living will specifies the types of medical treatments a person does or does not want at the end of life. Similar to a DNR, it serves as a clear instruction for healthcare providers and family members.
- Healthcare Proxy: This document designates an individual to make medical decisions on behalf of another person if they are unable to do so. It complements a DNR by ensuring that someone trusted can advocate for the patient's wishes.
- Power of Attorney for Healthcare: This allows a person to appoint someone to make healthcare decisions for them. It works alongside a DNR by providing a legal framework for someone to act on the patient's behalf regarding medical care.
- Physician Orders for Life-Sustaining Treatment (POLST): POLST forms translate a patient's wishes regarding treatment into actionable medical orders. Like a DNR, it is designed for patients with serious illnesses to ensure their preferences are respected.
- Do Not Intubate (DNI) Order: A DNI order specifically instructs medical personnel not to insert a breathing tube if a patient cannot breathe on their own. It is similar to a DNR in that it reflects the patient's wishes about life-sustaining interventions.
- Patient Care Preferences: This document outlines a patient's specific wishes regarding their care, including comfort measures and end-of-life decisions. It parallels a DNR by emphasizing the importance of respecting patient autonomy in medical decisions.