Blank Iowa Do Not Resuscitate Order Form

• Advance Directive: This document outlines a person's wishes regarding medical treatment in situations where they cannot communicate their preferences. Like a Do Not Resuscitate Order (DNR), it ensures that healthcare providers respect a patient’s choices about life-sustaining measures.

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• Living Will: A living will is a type of advance directive that specifically details what medical treatments one does or does not want at the end of life. It often includes preferences about resuscitation, similar to a DNR.
• Healthcare Proxy: This document designates an individual to make healthcare decisions on behalf of someone if they become unable to do so. It can work alongside a DNR by ensuring that the appointed person understands the patient’s wishes regarding resuscitation.
• Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that outlines a patient’s preferences for treatment in emergency situations. It goes beyond a DNR by addressing a range of life-sustaining interventions, ensuring clarity for medical personnel.
• Do Not Intubate Order: This order specifically instructs healthcare providers not to insert a breathing tube if a patient stops breathing. It is similar to a DNR in that it reflects a patient’s wishes regarding the extent of medical intervention.
• Comfort Care Order: This document emphasizes the goal of providing comfort rather than prolonging life. It aligns with the principles of a DNR by prioritizing quality of life over aggressive treatment.
• End-of-Life Care Plan: An end-of-life care plan details the overall approach to a patient’s care as they near death. It can incorporate a DNR and other directives to ensure that all aspects of care align with the patient’s wishes.
• Patient Bill of Rights: This document outlines the rights of patients in healthcare settings, including the right to make decisions about their treatment. It supports the principles of a DNR by affirming a patient’s autonomy in making healthcare choices.

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

   A Do Not Resuscitate Order is a legal document that allows a person to refuse certain medical treatments, specifically cardiopulmonary resuscitation (CPR), in the event their heart stops beating or they stop breathing. This order is meant to respect the wishes of individuals regarding their end-of-life care.

2. Who can create a DNR Order in Iowa?

   In Iowa, a DNR Order can be created by any adult who is capable of making their own healthcare decisions. This includes individuals who are at least 18 years old and are able to understand the implications of their choices.

3. How do I obtain a DNR Order form in Iowa?

   You can obtain a DNR Order form from various sources. Healthcare providers, hospitals, and online resources often provide the necessary forms. It is important to ensure that you are using the official Iowa DNR form to ensure its validity.

4. What information is required on the DNR Order form?

   The DNR Order form typically requires the following information:

   • Your full name
   • Your date of birth
   • Your signature
   • The signature of a healthcare provider
   • The date the form is signed
5. Is a DNR Order valid outside of a hospital setting?

   Yes, a DNR Order is valid in both hospital and non-hospital settings. However, it is crucial to ensure that emergency medical personnel are aware of the DNR Order. Carrying a copy of the order with you can help communicate your wishes in case of an emergency.

6. Can a DNR Order be revoked?

   Yes, a DNR Order can be revoked at any time. You can do this verbally or in writing. It is important to inform your healthcare provider and anyone who may be involved in your care about the revocation to ensure your current wishes are respected.

7. What if I change my mind about my DNR Order?

   If you change your mind about your DNR Order, you can create a new order or revoke the existing one. Make sure to communicate any changes to your healthcare providers and keep a copy of the new order accessible.

8. Will my DNR Order be honored in all situations?

   A DNR Order is generally honored in most medical situations. However, there may be instances, such as in certain surgical procedures, where resuscitation may be performed unless otherwise specified. Discuss your DNR Order with your healthcare provider to ensure clarity on when it applies.

9. How can I ensure my DNR Order is recognized?

   To ensure your DNR Order is recognized, keep a copy with you at all times, especially when traveling or receiving care. Inform your family, friends, and healthcare providers about your DNR wishes. Consider wearing a medical alert bracelet that indicates your DNR status.

When considering end-of-life care, it's essential to have the right documents in place. Along with the Iowa Do Not Resuscitate Order form, several other forms can help ensure that your wishes are respected. Here’s a list of documents that are often used in conjunction with the DNR order.

• Advance Directive: This document outlines your preferences for medical treatment if you become unable to communicate. It includes instructions about life-sustaining measures and appoints a healthcare proxy.
• Healthcare Power of Attorney: This form designates someone to make medical decisions on your behalf if you cannot do so. It’s important to choose someone you trust.
• Living Will: A living will specifies the types of medical treatment you want or don’t want in situations where you are terminally ill or permanently unconscious.
• Physician Orders for Life-Sustaining Treatment (POLST): This document translates your wishes regarding treatment into medical orders. It’s typically used for individuals with serious health conditions.
• Organ Donation Registration: If you wish to donate your organs after death, this document indicates your consent and outlines your preferences regarding organ donation.
• Do Not Intubate (DNI) Order: Similar to a DNR, a DNI order specifies that you do not want to be placed on a ventilator if you stop breathing or your heart stops.
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• Medication Orders: This form details the medications you are currently taking and any specific instructions regarding their use or cessation.
• Emergency Medical Services (EMS) Information: This document provides vital information for emergency responders, ensuring they understand your wishes and medical history.
• Patient Information Form: This form collects essential details about your medical history, allergies, and current treatments, helping healthcare providers deliver appropriate care.
• Family Communication Plan: This document outlines how you want your family to be informed about your health status and decisions regarding your care.

Having these documents prepared can ease the burden on your loved ones during difficult times. It’s important to discuss your wishes with family and healthcare providers to ensure everyone is on the same page. This proactive approach can lead to better care that aligns with your values and preferences.