Blank Do Not Resuscitate Order Template for the State of Iowa

Guidelines on Utilizing Iowa Do Not Resuscitate Order

When it comes time to make important health care decisions, understanding how to navigate the documentation is essential. If an individual decides, in agreement with their health care professional, that they do not want to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest, an Iowa Do Not Resuscitate (DNR) Order form needs to be properly filled out. This document plays a crucial role in ensuring that the wishes of the individual are respected by health care providers. Here are the steps to correctly fill out the form, ensuring clarity and compliance with Iowa law.

1. Gather necessary information including the full name of the patient, date of birth, and address to ensure the form is accurately associated with the correct individual.
2. Discuss the decision with a qualified health care provider to confirm that a DNR order is appropriate given the individual's medical condition and health care preferences. This discussion is mandatory as the health care provider's signature is required on the form.
3. Enter the patient's information into the specified section of the form, including name, date of birth, and any other requested identification information to ensure the order is unambiguously applied to the right person.
4. Read through the DNR order carefully with the health care provider to understand the implications of the order and ensure that it aligns with the patient's wishes for their care.
5. Have the health care provider sign the form in the designated area to validate the DNR order. The provider's signature confirms the medical advisability of the DNR order based on the patient's current health status and end-of-life care preferences.
6. The patient or the patient's legally authorized representative must then sign and date the form. If the patient is unable to sign, the representative, who may be a family member or legal guardian, must sign on their behalf, indicating their relationship to the patient.
7. Ensure a witness signs the form if required. The witness's role is to attest to the authenticity of the patient or the representative's signature.
8. Retain a copy of the completed DNR form and provide another to the primary health care provider to be included in the medical records. It's also wise to inform close family members or caregivers of the order and where the document is kept.

Completing the Iowa Do Not Resuscitate Order form is a significant step in health care planning. It requires thoughtful consideration and a clear conversation with health care professionals and loved ones. By carefully following these steps, individuals can ensure that their health care preferences are known, documented, and will be respected in critical situations. This document, while a delicate topic, is about empowering individuals to make choices that reflect their values and wishes regarding their medical care.

1. What is an Iowa Do Not Resuscitate Order?

   An Iowa Do Not Resuscitate Order (DNR) is a medical order signed by a healthcare provider. It instructs healthcare workers not to perform cardiopulmonary resuscitation (CPR) on a patient if their heart stops beating or if they stop breathing. This document is used by individuals who want to decline life-prolonging treatments in certain circumstances.

2. Who can request a Do Not Resuscitate Order in Iowa?

   Any competent adult can request a Do Not Resuscitate Order. Additionally, legal guardians, healthcare agents, or surrogate decision-makers can request a DNR on behalf of someone who is not able to make their own healthcare decisions, as long as it aligns with the patient's wishes or best interests.

3. How can one obtain a Do Not Resuscitate Order in Iowa?

   Obtaining a DNR order in Iowa involves consulting with a healthcare provider who can assess the patient's health condition and discuss the implications of a DNR order. If a DNR order aligns with the patient's wishes and healthcare goals, the healthcare provider can issue the order. It must then be properly documented and included in the patient’s medical records.

4. Is the DNR applicable in all healthcare settings?

   Yes, a valid DNR order is honored in all healthcare settings in Iowa, including hospitals, nursing homes, and by emergency medical services. However, it’s important for patients or their representatives to ensure that the DNR order is accessible to healthcare providers in every setting where they receive care.

5. Can a Do Not Resuscitate Order be revoked?

   Yes, a DNR can be revoked at any time by the patient or their authorized representative. Revocation can be done verbally or in writing. Once revoked, healthcare providers will no longer follow the DNR order and will perform all necessary life-saving treatments unless a new DNR order is issued.

6. What is the difference between a Do Not Resuscitate Order and a living will?

   A DNR order specifically instructs healthcare providers not to perform CPR if a patient's breathing or heart stops. A living will, on the other hand, is a broader legal document that outlines a person’s wishes regarding various types of medical treatments and interventions in the event they are unable to make decisions themselves. Both documents are important parts of advanced healthcare planning, but they serve different functions.

Filling out any legal form requires attention to detail, especially when it comes to something as critical as a Do Not Resuscitate (DNR) Order. In Iowa, making mistakes on this form can lead to significant consequences regarding emergency medical care. Here are six common errors people tend to make when completing their Iowa Do Not Resuscitate Order form:

1. Not Consulting with a Healthcare Provider: It's essential to discuss your medical condition and the implications of a DNR order with a healthcare provider before filling out the form. This ensures that the decision is informed and reflects your current health status and wishes.

2. Incorrect or Incomplete Patient Information: The form requires accurate patient information, including full name, date of birth, and other personal details. Mistakes or incomplete fields can render the form invalid or lead to confusion in emergency situations.

3. Failing to Have the Form Properly Signed: An Iowa DNR order must be signed by the patient (or their authorized representative if the patient is unable to sign) and the attending physician. Missing signatures can invalidate the entire document.

4. Not Including Specific Instructions: While the DNR form indicates a general wish not to have resuscitative efforts, any additional specific wishes regarding treatment options should also be clearly stated to ensure they are followed.

5. Using an Outdated Form: Laws and regulations change, and so do the forms. Using an outdated version of the Iowa DNR Order form might mean it doesn't comply with current legal requirements, potentially making it unenforceable.

6. Not Distributing Copies Appropriately: After completing the form, it's crucial to distribute copies to the relevant parties, such as family members, healthcare providers, and potentially your lawyer. Failure to do so can lead to situations where your DNR order is not honored because it is not readily available during an emergency.

Avoiding these mistakes can ensure that your wishes regarding resuscitation are clearly understood and respected. Always remember, when in doubt, seek the guidance of a professional to assist with the completion and distribution of this critical document.

When discussing end-of-life wishes, the Do Not Resuscitate (DNR) Order is often one of the most critical documents. However, it's just one piece of the larger conversation about medical care preferences and legal arrangements that individuals may consider as they plan for the future. Alongside a DNR, several other forms and documents can play a vital role in ensuring a person's wishes are respected and that their affairs are in order. Here are ten other forms and documents often used in conjunction with an Iowa DNR Order:

• Advance Directive – This document allows individuals to outline their healthcare preferences, including end-of-life care, long before the need arises. It can also designate a healthcare power of attorney to make decisions when the individual is unable to do so.
• Living Will – Specifically focused on end-of-life care, a living will communicates an individual's desires regarding life-sustaining treatments if they become terminally ill or permanently unconscious.
• Power of Attorney for Health Care – This legal document grants another person the authority to make healthcare decisions on an individual's behalf if they are unable to make those decisions themselves.
• Medical Orders for Scope of Treatment (MOST) – The MOST form translates an individual's end-of-life wishes into medical orders, ensuring that healthcare providers are aware of their preferences for treatment.
• Physician Orders for Life-Sustaining Treatment (POLST) – Similar to a MOST, this form offers detailed medical orders based on the individual's current medical condition and their preferences about treatments like intubation, mechanical ventilation, and antibiotics.
• Financial Power of Attorney – This form appoints someone to handle financial decisions and transactions on behalf of the individual, which is especially important if they become incapacitated.
• Last Will and Testament – This legal document outlines how an individual's assets will be distributed upon their death, designating beneficiaries and possibly establishing trusts.
• HIPAA Release Form – The Health Insurance Portability and Accountability Act (HIPAA) protects an individual's medical records, but this form authorizes designated persons to access those records and communicate with healthcare providers.
• Funeral Planning Declaration – This document allows individuals to specify their wishes for their funeral services, burial or cremation, and even the handling of their remains, helping to relieve their loved ones of these decisions.
• Organ and Tissue Donation Registration – By registering as an organ donor, individuals can provide instructions regarding the donation of their organs and tissues for transplantation after death.

Managing end-of-life documents, including a DNR order, involves careful consideration and often discussions with loved ones and healthcare providers. Each document serves a different purpose, addressing aspects of healthcare, financial management, and personal wishes regarding treatment and after-death care. By understanding and completing these forms, individuals can have greater control over their future, ensuring their wishes are respected and providing peace of mind for themselves and their families.

• Living Will: A Living Will closely mirrors a Do Not Resuscitate (DNR) Order in its basic purpose, which is to guide healthcare providers about a patient's preferences in life-threatening medical situations. Both documents focus on the individual's desires regarding medical treatments or interventions at the end of life. The key similarity lies in their preemptive nature, allowing individuals to make their wishes known before they are unable to communicate them due to medical incapacitation. While a DNR specifically addresses the act of not performing CPR (cardiopulmonary resuscitation), a Living Will covers a broader range of medical treatments and interventions, including life support and artificial nutrition.

• Medical Power of Attorney (Healthcare Proxy): This document is akin to a DNR Order in that it deals with medical decisions when a person is incapacitated. A Medical Power of Attorney designates another individual to make healthcare decisions on behalf of the grantor, should the latter become unable to do so. The parallel to a DNR lies in the preparation for a scenario where the individual cannot express their medical preferences. However, the scope of a Medical Power of Attorney is broader, as it empowers the proxy to make a wide range of healthcare decisions, not limited to the rejection of resuscitation efforts.

• Advanced Healthcare Directive: This document encompasses the qualities of both a Living Will and a Medical Power of Attorney, offering a comprehensive approach to pre-planned healthcare decision-making, similar to a DNR Order. An Advanced Healthcare Directive lays out a person’s specific wishes regarding healthcare interventions, including preferences about life-sustaining treatment, in addition to appointing a healthcare proxy. The correlation with a DNR Order exists in the directive nature of both documents, aiming to ensure that the individual’s healthcare preferences are honored in situations where they cannot communicate them personally.

• POLST (Physician Orders for Life-Sustaining Treatment) Form: POLST forms bear a significant resemblance to DNR Orders due to their specific focus on end-of-life care instructions. Both are legally binding documents that outline a patient's preferences regarding certain medical procedures, including resuscitation. A key distinction is that while a DNR Order specifically addresses the desire not to undergo CPR, a POLST Form can detail broader preferences regarding other types of life-sustaining treatments such as intubation or the use of antibiotics. Importantly, a POLST is usually filled out in consultation with a healthcare provider, ensuring that the patient's wishes regarding treatment are clear and can be immediately implemented by healthcare professionals.

When completing the Iowa Do Not Resuscitate (DNR) Order form, it is important to follow specific guidelines to ensure the document is legal and effective. Here are four recommendations for what you should and shouldn't do during the process:

Do:

1. Verify the patient's eligibility. The person must be of age or have a legal guardian, and the form must be in line with Iowa laws.
2. Ensure the form is completely and accurately filled out. All required fields should be filled in with the correct information.
3. Obtain the necessary signatures. The form must be signed by the patient or their legal representative, and the attending healthcare provider.
4. Keep the DNR order accessible. Once completed and signed, the form should be kept in a place where it can be easily found by emergency personnel.

Don't:

1. Fill out the form without consent from the patient or their authorized representative. Consent is mandatory for the form to be valid.
2. Leave sections of the form blank. Incomplete forms may not be honored by healthcare professionals.
3. Alter the form after it has been signed. Any modifications to the DNR order must be made with the consent of all parties involved.
4. Forget to review and renew the form if necessary. DNR orders should be reviewed periodically to ensure they reflect the patient's current wishes.

Many misconceptions surround the Iowa Do Not Resuscitate (DNR) Order form. These misunderstandings can cause confusion and stress for individuals and their families when making important medical decisions. It's essential to shed light on these misconceptions to ensure that everyone is well-informed and can make choices that align with their wishes and values.

• Misconception 1: A Do Not Resuscitate (DNR) order means that no medical treatment will be provided.
  In reality, a DNR order specifically instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a person's breathing stops or if the heart stops beating. It does not limit other treatments that may be necessary and beneficial.

• Misconception 2: Only older adults can have a DNR order.
  DNR orders are not restricted by age. They are appropriate for individuals of any age who wish to refuse CPR for various reasons, including specific medical conditions or personal beliefs.

• Misconception 3: A DNR order cannot be changed once it has been implemented.
  Individuals can revoke or modify their DNR orders at any time. It's vital for these wishes to be communicated clearly to healthcare providers and family members.

• Misconception 4: A DNR order is the same as a living will.
  A DNR order and a living will serve different purposes. A living will is a broader document that outlines a person's wishes regarding a variety of medical treatments in the event that they become unable to express their preferences. A DNR order specifically addresses the use of CPR.

• Misconception 5: DNR orders are only valid in hospitals.
  DNR orders are valid and must be respected in any setting, including at home, in hospices, and in nursing homes, as long as they have been properly documented and communicated to the healthcare providers.

• Misconception 6: The family can override a DNR order.
  If a DNR order has been established and is part of a patient's medical records, healthcare providers are required to follow it, even if family members disagree with the decision.

• Misconception 7: Emergency medical services (EMS) personnel are not required to follow DNR orders.
  In Iowa, EMS personnel are legally required to follow a properly documented DNR order. Communication and clear identification of DNR orders are crucial in these situations.

• Misconception 8: DNR orders are automatically transferred between healthcare facilities.
  When a patient is transferred between facilities, it is essential to ensure that the DNR order is communicated and documented at the new facility. DNR orders do not automatically follow a patient and require active management to ensure continuity of care.

• Misconception 9: A DNR order is required to stop treatment.
  Stopping treatment is a separate decision from a DNR order, which specifically refers to not starting CPR in the event of cardiac or respiratory arrest. Decisions about stopping other forms of treatment should be discussed with healthcare providers.

• Misconception 10: All doctors will automatically know and respect a patient's DNR status.
  While medical professionals should respect a DNR order, it's crucial for patients and families to ensure that all members of a healthcare team are aware of the order. This might involve discussing it with various healthcare providers and ensuring it is clearly documented and accessible in the patient's medical record.

Understanding these misconceptions helps clarify the purpose and scope of a DNR order, allowing individuals and their families to make informed healthcare decisions that reflect their wishes and values.

Understanding the nuances of a Do Not Resuscitate (DNR) Order is crucial, especially when considering this directive in the state of Iowa. Here are some key takeaways intended to guide individuals through the process of filling out and utilizing the Iowa Do Not Resuscitate Order form, ensuring their wishes regarding emergency medical care are respected.

• The Iowa Do Not Resuscitate Order must be completed by a licensed healthcare provider in consultation with the patient or the patient's authorized representative. This emphasizes the importance of open communication between the patient and their healthcare provider.
• This form is designed to inform medical personnel that a patient does not wish to have cardiopulmonary resuscitation (CPR) in the event their heart stops or they stop breathing. Understanding and clearly stating one's preferences regarding such interventions is critical.
• Clear identification is key. Once completed, the DNR Order should be kept in a place where it can be easily found by emergency responders, such as with the patient or in a prominent place within the patient’s residence.
• The DNR Order applies both in healthcare facilities and at home. Patients or their representatives must ensure that the presence of the order is communicated across all settings where the patient receives care.
• It is advisable to review and potentially update the DNR Order periodically, especially if the patient's health status changes. This ensures that the order remains relevant to the patient's current health care preferences.
• Discussing one's wishes regarding resuscitation with family members and loved ones is as important as completing the form. These conversations can help to ensure that everyone involved understands the patient's preferences, reducing confusion and conflict in emergency situations.
• Should the patient or their legal representative decide to revoke the DNR Order, it is essential to communicate this decision promptly to all relevant parties, including healthcare providers and family members. Documentation of the revocation should be thorough, with physical evidence of the order's destruction when possible.

Comprehension and respect for these key facets can significantly influence the efficacy and respect of a patient's end-of-life wishes in Iowa. Properly executed, an Iowa Do Not Resuscitate Order ensures that patients maintain control over their end-of-life care decisions, reflecting their values and preferences during critical moments.