Printable Do Not Resuscitate Order Form for the State of Georgia Open Do Not Resuscitate Order Editor

Printable Do Not Resuscitate Order Form for the State of Georgia

A Georgia Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to refuse resuscitation in the event of cardiac arrest or respiratory failure. This form ensures that a person's wishes regarding end-of-life care are respected by medical professionals. If you wish to take control of your healthcare decisions, consider filling out the DNR form by clicking the button below.

Open Do Not Resuscitate Order Editor

Key takeaways

When filling out and using the Georgia Do Not Resuscitate Order (DNR) form, it is important to understand several key aspects to ensure it meets your needs and is legally valid.

  • Eligibility: The DNR order is intended for individuals who have a terminal illness or a condition that significantly limits their life expectancy. It's crucial to assess eligibility with a healthcare provider.
  • Completion Process: The form must be completed and signed by the patient (or their legal representative) and a physician. This ensures that the order is valid and recognized by medical personnel.
  • Communication: It is vital to communicate your wishes to family members and healthcare providers. Keep copies of the DNR order in accessible locations, such as with your medical records or at home.
  • Review and Update: Regularly review the DNR order, especially if there are changes in health status or personal wishes. Updating the document ensures that it reflects your current preferences.

Documents used along the form

When considering end-of-life decisions, individuals in Georgia may encounter several important documents alongside the Do Not Resuscitate (DNR) Order form. Each document serves a unique purpose and can help ensure that a person's medical preferences are honored. Here’s a brief overview of some commonly used forms.

  • Advance Directive for Health Care: This document allows individuals to specify their healthcare preferences in advance, including decisions about life-sustaining treatments and appointing a healthcare agent to make decisions on their behalf if they become unable to do so.
  • Arizona Quitclaim Deed: For property transfers in Arizona, you can utilize an All Arizona Forms to facilitate the process efficiently.
  • Living Will: A living will outlines a person's wishes regarding medical treatment in situations where they are terminally ill or permanently unconscious. It focuses on the types of medical interventions the individual does or does not want.
  • Healthcare Power of Attorney: This form designates a specific person to make healthcare decisions for someone if they are incapacitated. The appointed individual can make choices based on the patient’s wishes and best interests.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that outlines a patient's preferences for life-sustaining treatments. It is intended for patients with serious illnesses and must be signed by a physician.
  • Do Not Intubate (DNI) Order: This order specifically instructs medical personnel not to insert a breathing tube in the event of respiratory failure, complementing the DNR order.
  • Organ Donation Consent Form: This document indicates a person's wishes regarding organ donation after death. It can be included in an advance directive or completed separately.
  • Patient Advocate Designation: Similar to a healthcare power of attorney, this form allows individuals to appoint someone to advocate for their wishes in medical situations, ensuring their preferences are communicated and respected.
  • Emergency Medical Services (EMS) Do Not Resuscitate Order: This form is specifically designed for use by emergency medical services. It informs responders that a patient does not wish to receive resuscitation efforts in case of a medical emergency.

Understanding these documents can empower individuals to make informed decisions about their healthcare and ensure that their wishes are respected. It’s essential to discuss these forms with family members and healthcare providers to ensure clarity and understanding.

Similar forms

  • Advance Directive: This document outlines a person's healthcare preferences in case they become unable to communicate their wishes. Like a DNR, it provides guidance on the types of medical interventions a patient does or does not want.

  • Living Will: A living will specifies a person's wishes regarding end-of-life care. It often includes decisions about life-sustaining treatments, similar to the choices made in a DNR.

  • Durable Power of Attorney for Healthcare: This document designates someone to make medical decisions on behalf of a person if they are incapacitated. It complements a DNR by ensuring that someone trusted can advocate for the patient's wishes.

  • Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that details a patient's preferences for treatment in emergency situations. It is similar to a DNR in that it guides healthcare providers on what actions to take.

  • Do Not Intubate (DNI) Order: A DNI order specifically instructs healthcare providers not to place a patient on a ventilator. This is often used alongside a DNR to clarify a patient's wishes regarding respiratory support.

  • Comfort Care Order: This document focuses on providing relief from pain and discomfort without aggressive treatments. It aligns with a DNR by prioritizing quality of life over invasive procedures.

  • Last Will and Testament Form: To ensure your final wishes are respected, utilize the important Last Will and Testament resources for effective estate planning and asset distribution.

  • Emergency Medical Services (EMS) Protocols: These protocols guide first responders on how to act in emergencies. A DNR may be included in these protocols to ensure that a patient's wishes are respected during an emergency.

  • Patient Preferences Document: This informal document outlines a patient's healthcare preferences, including their stance on resuscitation. It serves a similar purpose as a DNR by communicating wishes to healthcare providers.

  • Healthcare Proxy: A healthcare proxy is a person designated to make medical decisions on behalf of a patient. While it does not specify treatment preferences, it works in tandem with a DNR to ensure that a patient's wishes are honored.

  • Withdrawal of Treatment Orders: These orders provide instructions for discontinuing specific medical treatments. They can be similar to a DNR in that they prioritize the patient's comfort and autonomy in decision-making.

Document Features

Fact Name Description
Definition A Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform CPR if a person's heart stops or they stop breathing.
Governing Law The Georgia Do Not Resuscitate Order is governed by O.C.G.A. § 31-39-1 et seq.
Eligibility Any adult or emancipated minor can create a DNR Order in Georgia.
Signature Requirement The DNR Order must be signed by the patient or their legal representative, and a physician must also sign it.
Form Availability The official Georgia DNR Order form is available through the Georgia Department of Public Health.
Revocation A DNR Order can be revoked at any time by the patient or their representative, verbally or in writing.
Emergency Medical Services Emergency medical services (EMS) must honor a valid DNR Order and refrain from resuscitation efforts.
Placement The DNR Order should be kept in a prominent place, such as on the refrigerator or with the patient’s medical records.
Limitations A DNR Order only applies to resuscitation efforts and does not affect other medical treatments.

Some Other Do Not Resuscitate Order State Forms

Common mistakes

  1. Failing to complete all required sections of the form. Each part of the Georgia Do Not Resuscitate Order form must be filled out completely to ensure clarity of intent.

  2. Not signing the form. The absence of a signature can render the document invalid, making it crucial for the individual or their legal representative to sign.

  3. Using outdated versions of the form. It's important to ensure that the most current version of the form is being used, as regulations may change.

  4. Neglecting to discuss the order with healthcare providers. Open communication with medical professionals can help clarify the implications of the order.

  5. Forgetting to provide copies to relevant parties. After completing the form, copies should be given to healthcare providers, family members, and anyone involved in the individual’s care.

  6. Not reviewing the form periodically. Life circumstances can change, and it is important to revisit the order to ensure it still reflects the individual's wishes.

  7. Misunderstanding the implications of a DNR order. Individuals should fully understand what a Do Not Resuscitate Order entails, including its impact on emergency medical care.

  8. Failing to include a witness signature when required. Some situations may necessitate a witness to validate the order, so it is important to check the requirements.

  9. Not considering advance care planning. A DNR order is just one aspect of end-of-life planning; individuals should consider other directives as well.

  10. Overlooking the need for updates after a significant life event. Changes such as marriage, divorce, or a new diagnosis may necessitate a review and update of the DNR order.

Preview - Georgia Do Not Resuscitate Order Form

Georgia Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order (DNR) is made in accordance with the laws of the State of Georgia. It is designed to express the wishes of the individual regarding resuscitation efforts in the event of a medical emergency.

Patient Information:

  • Full Name: ________________________________
  • Date of Birth: ________________________________
  • Address: ________________________________

Physician Information:

  • Physician's Name: ________________________________
  • Medical License Number: ________________________________
  • Contact Number: ________________________________

This DNR Order states that the patient does not wish to receive cardiopulmonary resuscitation (CPR) or other life-saving measures in the event of cardiac or respiratory arrest. It is paramount for all healthcare providers to respect this directive.

Patient’s Signature: ________________________________

Date: ________________________________

Witness Information:

  • Witness's Name: ________________________________
  • Contact Number: ________________________________

By signing this document, both the patient and the witness acknowledge their understanding of the content and implications of this Do Not Resuscitate Order.

This document should be kept in an accessible location and presented to all healthcare providers involved in the patient's care.