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Fillable Do Not Resuscitate Order Form for Michigan

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Documents used along the form

The Michigan Do Not Resuscitate (DNR) Order form is an important document that allows individuals to express their wishes regarding medical treatment in emergencies. Along with this form, there are several other documents that may be used to ensure that a person's healthcare preferences are respected. Below is a list of these forms and documents.

  • Advance Directive: This document outlines a person's preferences for medical care if they become unable to communicate their wishes. It can include instructions about life-sustaining treatments, organ donation, and other healthcare decisions.
  • Durable Power of Attorney for Healthcare: This form designates a trusted individual to make healthcare decisions on behalf of someone else. This agent can act when the person is unable to make their own decisions due to illness or incapacity.
  • Living Will: A living will specifies the types of medical treatments a person does or does not want in specific situations, such as terminal illness or severe injury. It is a way to communicate preferences about end-of-life care.
  • Small Estate Affidavit: For efficient asset transfer without probate complications, consider using a step-by-step Small Estate Affidavit form guide to simplify the process for rightful heirs.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that reflects a patient's wishes regarding treatments like resuscitation, intubation, and feeding tubes. It is typically used for individuals with serious health conditions.
  • Healthcare Proxy: Similar to a durable power of attorney, this document allows someone to appoint another person to make healthcare decisions on their behalf. It often comes into play when a person cannot express their own wishes.

Understanding these documents can empower individuals to make informed choices about their healthcare. It is crucial to have these conversations with family and healthcare providers to ensure that one's preferences are clearly communicated and respected.

Michigan Do Not Resuscitate Order Preview

Michigan Do Not Resuscitate Order Template

This Do Not Resuscitate (DNR) Order is established in accordance with Michigan state laws regarding advance directives and medical decisions.

Patient Information:

  • Patient's Full Name: _______________
  • Date of Birth: _______________
  • Patient's Address: _______________

Contact Information for Substitute Decision Maker (if applicable):

  • Name: _______________
  • Relationship to Patient: _______________
  • Phone Number: _______________
  • Address: _______________

Medical Directive:

I, the undersigned patient, make this Do Not Resuscitate Order voluntarily. I understand that this order means that in the event of cardiac or respiratory arrest, the medical staff should not perform cardiopulmonary resuscitation (CPR) or any other resuscitative measures. I wish for my wishes to be respected in any medical emergency.

Patient's Signature: _______________

Date: _______________

Witnesses:

  1. Name: _______________ Signature: _______________ Date: _______________
  2. Name: _______________ Signature: _______________ Date: _______________

This DNR Order should be kept in a prominent place and a copy should be provided to the patient's healthcare providers.

Similar forms

  • Advance Directive: This document outlines a person's wishes regarding medical treatment in situations where they cannot communicate their preferences. Like a DNR, it helps ensure that medical staff respect the individual's choices.
  • Living Will: A living will specifies the types of medical treatment a person wishes to receive or avoid at the end of life. It is similar to a DNR in that it provides guidance on the person’s healthcare preferences.
  • Power of Attorney for Healthcare: This document designates someone to make medical decisions on behalf of an individual if they become unable to do so. It complements a DNR by ensuring that someone is authorized to uphold the wishes expressed in a DNR.
  • Lease Agreement: A Georgia Lease Agreement form is essential for outlining the terms and conditions between landlords and tenants, ensuring clarity and protection for all parties involved, and can be accessed through Forms Georgia.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST forms translate a patient's wishes about life-sustaining treatments into actionable medical orders. They are often used alongside DNRs to provide comprehensive care instructions.
  • Do Not Intubate (DNI) Order: A DNI order specifically instructs medical personnel not to place a patient on a ventilator if they stop breathing. This is similar to a DNR as both documents reflect a patient's wishes regarding resuscitation efforts.
  • Medical Orders for Scope of Treatment (MOST): This document is used to outline a patient's preferences for treatment in emergency situations. Like a DNR, it communicates critical healthcare decisions to emergency responders.
  • End-of-Life Care Plan: An end-of-life care plan addresses the overall approach to care as a person nears death. It often includes preferences regarding resuscitation, making it closely related to a DNR.
  • Patient Advocate Designation: This document allows individuals to appoint someone to advocate for their healthcare wishes. It is similar to a DNR in that it helps ensure that the patient’s preferences are respected in medical situations.

More Michigan Templates

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A Power of Attorney (POA) form is a legal document that grants one individual—the agent—the authority to act on behalf of another—the principal—in financial, legal, or health-related decisions. This empowering document can serve as a critical tool in ensuring that a trusted individual can make decisions when the principal is unable to do so themselves. To ensure your wishes are honored and your affairs are handled appropriately, consider filling out a Power of Attorney form.

Free Michigan Power of Attorney Forms to Print - This form is a proactive step in managing one's legal and financial matters effectively.

Misconceptions

Understanding the Michigan Do Not Resuscitate (DNR) Order form can be challenging, and several misconceptions often arise. Here are four common misunderstandings:

  • A DNR order means that no medical care will be provided. This is not true. A DNR order specifically instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient’s heart stops or they stop breathing. However, it does not prevent other forms of medical treatment or care from being administered.
  • Only terminally ill patients can have a DNR order. This misconception can lead to confusion. While many people who choose a DNR may be facing terminal conditions, anyone can request a DNR order, regardless of their overall health status. The decision is personal and should reflect individual wishes regarding end-of-life care.
  • A DNR order is permanent and cannot be changed. This is incorrect. A DNR order can be revoked or modified at any time. Patients or their legal representatives have the right to change their minds about resuscitation preferences, and healthcare providers must respect those decisions.
  • DNR orders are only valid in hospitals. This is a common misunderstanding. In Michigan, DNR orders can be valid in various settings, including at home, in nursing facilities, and during transport. It is crucial that the DNR order is properly documented and communicated to all relevant parties to ensure it is honored in any environment.

Detailed Instructions for Using Michigan Do Not Resuscitate Order

Filling out the Michigan Do Not Resuscitate (DNR) Order form is an important step in ensuring your healthcare preferences are respected. After completing the form, it should be shared with your healthcare providers and kept in an accessible location. Here’s how to fill it out correctly.

  1. Begin by downloading the Michigan Do Not Resuscitate Order form from the official state website or obtain a hard copy from a healthcare provider.
  2. In the top section, fill in your full name, date of birth, and address. This information helps identify you clearly.
  3. Next, indicate whether you are completing the form for yourself or if it is being completed by a legally authorized representative.
  4. Provide the name of your attending physician. This is the doctor who is primarily responsible for your care.
  5. In the designated area, clearly mark your wishes regarding resuscitation. You may check the box that indicates you do not want resuscitation efforts.
  6. Sign and date the form. Your signature confirms that you understand and agree with the contents of the form.
  7. If applicable, have your attending physician sign the form as well. This step is often required to validate the DNR order.
  8. Make copies of the completed form for your medical records and for your family members or healthcare proxies.
  9. Finally, store the original form in a safe but accessible place, such as with your advance directives or in a medical file.

Dos and Don'ts

When filling out the Michigan Do Not Resuscitate Order form, it is important to follow specific guidelines to ensure that your wishes are clearly communicated. Here are five things you should and shouldn't do:

  • Do ensure that the form is completed in full, providing all required information.
  • Do discuss your wishes with your healthcare provider and family members.
  • Do sign and date the form to validate it.
  • Don't use any alterations or corrections on the form; it should be clean and clear.
  • Don't forget to keep copies of the signed form for your records and to share with your healthcare team.

Following these guidelines will help ensure that your Do Not Resuscitate Order is respected and understood by medical professionals. Clear communication is key.