Blank Do Not Resuscitate Order Template for the State of Illinois

Guidelines on Utilizing Illinois Do Not Resuscitate Order

A Do Not Resuscitate (DNR) Order in Illinois is an essential document for individuals who wish to decline resuscitation in the event of cardiac or respiratory arrest. This document ensures that medical professionals are aware of and respect the patient's wishes concerning life-saving measures. Completing this form requires clear understanding and precise information to ensure its validity and effectiveness. Below is a step-by-step guide designed to assist in the completion of the Illinois Do Not Resuscitate Order form.

1. Start by entering the patient's full legal name at the top of the form to clearly identify the subject of the DNR Order.
2. Provide the patient's date of birth and address to help healthcare providers verify the patient's identity.
3. Read the declaration section carefully. This section outlines the patient's wish not to receive cardiopulmonary resuscitation (CPR) in case of a cardiac or respiratory arrest.
4. If the patient is capable and willing to consent, they should sign and date the form in the presence of a witness. The witness must also sign and date the form, attesting to the patient's decision and capacity to make such a decision.
5. In cases where the patient cannot sign, a legal representative, such as a healthcare proxy or power of attorney holder, may fill out and sign the form on the patient's behalf. Enter the representative's name, relationship to the patient, and the basis for their authority to sign the DNR Order.
6. Ensure that a licensed healthcare professional reviews the form. This professional, often a physician, must confirm the patient's condition and the appropriateness of the DNR Order. The healthcare professional's signature and date are required for the document to be valid.
7. Review the completed form for accuracy and completeness. Verify that all required signatures and dates are present and clearly legible.
8. Finally, discuss the completed DNR Order with family members and healthcare providers to ensure that the patient's wishes are understood and will be respected. Keep the original document in an easily accessible place and consider giving copies to relevant parties, such as family members and primary care doctors.

Once all steps are carefully followed, and the Illinois Do Not Resuscitate Order form is fully completed and signed, it will serve as an important legal document. It guides healthcare professionals in providing care that aligns with the patient's end-of-life wishes. Remember, this form can be revised or revoked at any time by the patient or their designated legal representative, provided any changes are communicated clearly to all involved parties.

1. What is a Do Not Resuscitate (DNR) Order in Illinois?

   A DNR Order in Illinois is a legal document that instructs healthcare providers not to perform CPR (cardiopulmonary resuscitation) in the event a patient's breathing stops or if the patient's heart stops beating. This order is used by patients who wish to avoid aggressive medical interventions at the end of their life. It's part of a broader category of advance directives that allow individuals to make their healthcare preferences known in advance.

2. Who can create a DNR Order in Illinois?

   In Illinois, any adult with the capacity to make their own healthcare decisions can create a DNR Order. This includes verbally communicating their wishes to a healthcare provider in the presence of a witness, or more formally, through completing and signing the Illinois DNR Order form. If an adult is not capable of making their decisions, a legally recognized health care surrogate, guardian, or agent under a healthcare power of attorney can make this decision on their behalf.

3. How can someone get a Do Not Resuscitate Order form in Illinois?

   The DNR Order form in Illinois can typically be obtained through a healthcare provider, such as a doctor or hospital. Many healthcare providers in Illinois have access to the appropriate forms and can guide patients or their families through the process of completing them. Alternatively, the Illinois Department of Public Health's website also offers resources and forms available for download and printing.

4. Is the Illinois DNR Order recognized outside of hospital settings?

   Yes, the Illinois DNR Order is recognized outside of hospital settings, including in the patient's home, in nursing homes, and in hospice. This wide recognition allows for the patient's wishes regarding resuscitation to be honored across different care settings without the necessity for transfer to a hospital for life-sustaining treatment decisions.

5. Can a DNR Order in Illinois be revoked?

   Yes, a DNR Order in Illinois can be revoked at any time by the patient or their legally recognized healthcare surrogate. Revocation can be done in several ways, including orally by informing the healthcare provider, by physically destroying the DNR Order form, or by creating a new document that revokes the previous DNR Order. Healthcare providers should be immediately informed of any revocation to ensure medical records are updated accordingly.

6. What should be done with the DNR Order form once it is completed?

   Once the DNR Order form is completed, it should be placed in an easily accessible location where EMS personnel and healthcare providers can quickly find it in an emergency. Patients are also encouraged to inform family members, healthcare agents, and primary care doctors about the existence and location of the DNR Order. Some individuals choose to carry a card in their wallet or wear medical alert jewelry that indicates they have a DNR Order.

Filling out the Illinois Do Not Resuscitate (DNR) Order form is a critical process that requires attention to detail to ensure that the wishes of the patient or their authorized representative are accurately captured. Here are some common mistakes that are made during this process:

1. Not verifying patient information: Ensuring that the patient's full name, birth date, and other identifying information are correctly filled out is crucial. Mistakes in this section can lead to confusion and potential non-compliance in an emergency.

2. Omitting the signature of the patient or authorized representative: The form must be signed by the patient, or if the patient is unable to sign, by an authorized representative. Failure to secure this signature can render the form invalid.

3. Leaving the physician's signature blank: A physician, nurse practitioner, or physician assistant must sign the form to confirm the DNR order. Without this signature, the document may not be legally binding.

4. Incorrect or incomplete date fields: Dates are important to establish when the order was made and to ensure it is still valid. Sometimes people forget to fill in these fields or enter the dates incorrectly.

5. Not specifying the patient’s wishes clearly: The form is designed to specify the types of life-sustaining treatments that should not be performed. Unclear instructions can lead to misinterpretation during critical moments.

6. Misunderstanding the form’s purpose: Sometimes people think the form covers more medical decisions than it actually does. It is important to understand that it is specifically for DNR orders and does not address other medical treatments or power of attorney.

7. Failure to discuss the form with medical providers: It's essential that the patient’s healthcare providers are aware of and understand the DNR order. Not communicating this effectively can lead to undesired medical interventions.

8. Not distributing copies of the completed form: The DNR order should be readily available to healthcare providers, family members, and in some cases, legal representatives. Keeping it in a safe but inaccessible place defeats its purpose.

Avoiding these mistakes requires careful attention to the form’s details, clear communication with healthcare professionals, and ensuring that the form is kept in an accessible location. By taking these steps, individuals can ensure that their healthcare wishes are respected in critical situations.

In Illinois, the Do Not Resuscitate (DNR) Order is significant for patients who prefer not to have CPR (cardiopulmonary resuscitation) in the event their heart or breathing stops. However, this form is often accompanied by several other documents to ensure that a person's healthcare wishes are fully understood and respected. These documents complement the DNR Order by providing a more comprehensive view of the person's healthcare preferences.

• Power of Attorney for Healthcare: This legal document allows an individual to appoint someone they trust (a 'healthcare agent') to make healthcare decisions on their behalf in case they become unable to do so. This can include decisions beyond resuscitation, covering a broad range of medical treatments.
• Living Will: A Living Will is a written statement detailing a person’s desires regarding their medical treatment in circumstances where they are no longer able to express informed consent, especially concerning end-of-life care. Unlike a DNR Order, which specifically addresses CPR, a Living Will provides instructions for a variety of life-sustaining interventions.
• Practitioner Orders for Life-Sustaining Treatment (POLST): The POLST form complements a DNR by providing specific instructions about other types of life-sustaining treatment, such as feeding tubes or antibiotics, in addition to CPR. It is intended for seriously ill individuals or those with a limited life expectancy.
• Medical Orders for Scope of Treatment (MOST): Similar to a POLST, a MOST outlines a comprehensive plan for end-of-life care, detailing what types of medical intervention a person wishes to receive or avoid. This can include preferences about resuscitation, hospitalization, antibiotics, and more.
• Healthcare Information Release Authorization: This document gives healthcare providers permission to share an individual’s health information with specified persons or entities. This is crucial in ensuring that all members of a healthcare team, as well as any designated healthcare agents or family members, have access to the necessary information to make informed decisions.

Collectively, these documents ensure that individual healthcare preferences are well-documented and can be respected by healthcare providers, particularly in situations where the individual cannot communicate their wishes. Including these documents with a DNR Order provides a comprehensive approach to healthcare planning, covering a wide range of scenarios and treatments beyond the scope of CPR and resuscitation.

• Living Will: A living will is similar to a Do Not Resuscitate (DNR) Order in that it also provides instructions regarding medical treatment when a person is unable to make decisions for themselves. While a DNR specifically focuses on the refusal of CPR or advanced cardiac life support, a living will can address a wider range of medical interventions, including life support and end-of-life treatments.

• Health Care Proxy or Medical Power of Attorney: This document appoints someone else to make medical decisions on a person’s behalf. Like a DNR, it comes into play when the individual cannot voice their medical wishes. However, it covers a broader scope of medical decisions beyond CPR and life-saving measures.

• Advanced Directive: An advanced directive is an overarching term that includes DNR orders, living wills, and health care proxies. It provides instructions for medical care ahead of time. The DNR is a specific type of advanced directive focusing exclusively on the refusal of resuscitation.

• Physician Orders for Life-Sustaining Treatment (POLST): Similar to a DNR, a POLST is designed for seriously ill patients and outlines a plan for end-of-life treatment, including the patient's wishes about resuscitation. Unlike a DNR, the POLST covers a range of treatments beyond resuscitation, such as hospitalization, intubation, and antibiotics.

• Do Not Intubate (DNI) Order: A DNI Order is closely related to a DNR in that it specifies the refusal of a specific life-saving procedure, in this case, intubation. Both documents are used to communicate a patient's wishes regarding the extent of medical intervention they desire at the end of life.

• Emergency Medical Services (EMS) Do Not Resuscitate Order: This is a specific kind of DNR intended for emergency medical services personnel. It is similar to a hospital-issued DNR but is specifically designed for situations outside of the hospital, informing first responders of the patient’s wishes concerning CPR and advanced life support.

Filling out the Illinois Do Not Resuscitate (DNR) Order form is a significant act that requires attentiveness and precision. It conveys a patient's preference not to undergo CPR (Cardiopulmonary Resuscitation) in the event their heart stops or they stop breathing. Below is a list of dos and don'ts to guide you through this sensitive and crucial process.

• Do ensure that the form is the current version recognized by Illinois. Regulations and forms can be updated, so it's important to use the most recent version.
• Do discuss the decision with a healthcare provider. It's vital to understand the implications of a DNR order fully.
• Do fill out the form with clear, legible handwriting. The information provided needs to be accessible to healthcare professionals in an emergency.
• Do verify the patient's information carefully. Double-check the spelling of the patient's name and other personal details to avoid any confusion.
• Do not sign the form without the presence of a witness or notary, depending on the state requirement. Their oversight ensures the document's legal standing.
• Do make sure the witness or notary also signs and dates the form, if applicable, to validate the DNR order.
• Do not fill out the form in a hurry. Take your time to review each section and make sure it accurately reflects the wishes of the patient.
• Do not forget to share the completed DNR order with immediate family members and the patient's healthcare provider. It’s important that they are aware of the patient's wishes and know where the document is stored.

By closely following these guidelines, you can ensure that the DNR order is completed correctly and will be upheld in critical situations. Remember, a DNR order is a powerful document that requires thoughtful consideration and clear communication with all involved parties.

The Illinois Do Not Resuscitate (DNR) Order is often misunderstood, with misconceptions surrounding its purpose, implications, and use. Here, we aim to clarify some of these misunderstandings to ensure individuals are fully informed about what the DNR entails.

• It's only for the elderly: Many people believe that DNR orders are exclusively for older adults. However, the eligibility for a DNR order is not age-specific. It is an option for individuals at any age who, due to a severe medical condition, do not wish to have cardiopulmonary resuscitation (CPR) in the event their breathing stops or their heart stops beating.

• DNR equals giving up on life: This perception is far from true. Choosing a DNR is a deeply personal decision, often made after careful consideration and discussion with healthcare providers and loved ones. It's about how one wants the end of their life to be managed, respecting their wishes and medical condition, rather than an act of surrender.

• DNR orders are irreversible: Some people think once a DNR order is signed, it cannot be changed. This is incorrect. DNR orders can be rescinded or modified at any time by the individual or their authorized healthcare proxy if the individual's capacity to make decisions is impaired. These changes can reflect new information, a change in health status, or a change in personal preferences.

• A DNR order means "do not treat": A common misconception is that a DNR order means medical personnel will not provide treatment. In reality, a DNR order specifically refers to not performing CPR. It does not mean refusing other forms of medical intervention or comfort care that can relieve pain and suffering or address other health issues.

• Only the patient can request a DNR: While it's true that patient autonomy is a cornerstone of the DNR process, there are circumstances where others may be involved in the decision. If the individual is unable to make their own healthcare decisions due to incapacity, a legally authorized representative, such as a healthcare proxy, durable power of attorney for healthcare, or a family member (where recognized by state law), can request a DNR order in line with the individual's known wishes or best interests.

Filling out and using the Illinois Do Not Resuscitate (DNR) Order form requires careful consideration and understanding of its implications. This document is crucial for those who wish to specify their desires regarding life-saving treatments in emergencies. Here are key takeaways to guide you through this sensitive process:

• An Illinois DNR Order tells emergency medical personnel not to perform cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. It’s a decision that should align with your healthcare wishes.
• The DNR Order needs to be signed by both the patient (or their legally authorized representative) and the patient’s physician. This dual-signature requirement ensures that both parties have discussed and agree upon the decision not to pursue resuscitation.
• Beyond CPR, the DNR Order does not preclude receiving other forms of medical treatment. Patients can still receive treatments that provide comfort and alleviate pain, ensuring their dignity and preferences are respected.
• For the DNR Order to be effectively implemented, it must be readily available. Emergency responders must see the document to honor your wishes, so it should be kept in an easily accessible location.
• Discussing your decision with family, close friends, and healthcare providers is essential. Clarity about your wishes can reduce confusion and distress during critical moments, helping ensure that your preferences are followed.
• Modifying or revoking a DNR Order can be done at any time. These changes should reflect your current healthcare wishes and be communicated to all relevant parties, including updating the signed DNR form.
• The Illinois DNR Order is specific to the state of Illinois. If you travel or move to another state, the document might not be automatically recognized. You should look into the requirements of your new location to ensure your healthcare wishes are respected everywhere.

Properly filled out and utilized, an Illinois DNR Order communicates your healthcare preferences clearly, ensuring that your treatment aligns with your values and wishes. It represents a crucial component of healthcare planning, empowering you to have a say in your treatment even when you might not be able to express your wishes verbally.