Blank Do Not Resuscitate Order Template for the State of Minnesota
In the realm of healthcare decisions, the Minnesota Do Not Resuscitate (DNR) Order form serves as a crucial tool for individuals wishing to express their preferences regarding life-sustaining treatments. This legally binding document allows patients to indicate that they do not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest or respiratory failure. Designed for those facing serious health conditions or end-of-life situations, the DNR form must be completed with careful consideration, involving discussions with healthcare providers and loved ones. It requires the signature of both the patient and a physician, ensuring that the patient’s wishes are respected and legally recognized. Additionally, the form provides clear instructions for emergency medical personnel, guiding them in the event of a medical crisis. Understanding the implications and procedures surrounding the DNR Order is essential for anyone considering this important decision, as it empowers individuals to take control of their medical care and ensures that their values and preferences are honored during critical moments.
Form Example
This Minnesota Do Not Resuscitate (DNR) Order template is designed to comply with the specific statutes of the state of Minnesota. It allows individuals to make informed decisions about their end-of-life care, ensuring their wishes are respected.
Complete the following information to create a valid DNR Order in Minnesota:
- Full Name of the Individual (Patient): ____________________________
- Date of Birth: ____________________________
- Address: ____________________________
- Primary Physician: ____________________________
- Physician's Contact Information: ____________________________
- Patient's Signature: ____________________________
- Date: ____________________________
- Witness Signature: ____________________________
- Witness Name (Printed): ____________________________
- Date: ____________________________
- Physician's Signature: ____________________________
- Date: ____________________________
By signing this document, the patient acknowledges their understanding and desire not to receive cardiopulmonary resuscitation (CPR) in the event that their breathing stops or if their heart ceases beating. This decision is made in accordance with Minnesota state-specific laws and is binding across healthcare settings within the state.
It is recommended that this document is reviewed regularly and kept in a location where it can be easily accessed by healthcare providers, family members, or caregivers. For more comprehensive planning, consider consulting with a healthcare provider or legal professional.
File Specs
| Fact Name | Description |
|---|---|
| Purpose | The Minnesota Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation efforts in the event of a medical emergency. |
| Governing Law | This form is governed by Minnesota Statutes, Section 144A.44, which outlines the legal framework for DNR orders in the state. |
| Eligibility | Any adult capable of making healthcare decisions can complete a DNR order. Additionally, a parent or legal guardian can sign for a minor. |
| Revocation | A DNR order can be revoked at any time by the individual or their authorized representative, ensuring that personal wishes are respected. |
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