Do Not Resuscitate Order Form for Missouri Open This Do Not Resuscitate Order Now

Do Not Resuscitate Order Form for Missouri

A Missouri Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to express their wishes regarding medical treatment in the event of a life-threatening situation. By completing this form, you can ensure that your preferences about resuscitation efforts are respected by healthcare providers. If you want to take control of your medical decisions, consider filling out the form by clicking the button below.

Open This Do Not Resuscitate Order Now
Article Guide

The Missouri Do Not Resuscitate Order (DNR) form serves as a critical document for individuals who wish to express their preferences regarding medical treatment in emergency situations. This form is particularly important for patients with terminal illnesses or those who may not want aggressive life-saving measures taken during a medical crisis. By completing the DNR form, individuals can communicate their wishes to healthcare providers, ensuring that their decisions about resuscitation are respected. The document must be signed by both the patient and a physician, affirming that the patient understands the implications of the order. Additionally, the form is designed to be easily recognizable, often printed on bright yellow paper, to facilitate quick access by medical personnel in emergencies. Understanding the requirements and implications of the Missouri DNR form is essential for patients, families, and healthcare providers alike, as it plays a vital role in end-of-life care planning and respecting patient autonomy.

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Missouri Do Not Resuscitate Order

This document serves as a directive in accordance with the Missouri Do Not Resuscitate (DNR) protocol as outlined in state laws. It communicates the decision of an individual, or their authorized representative, not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. Completion of this form is voluntary and should be considered carefully with the advice of a healthcare provider.

Patient Information:

  • Name: __________________________________________________
  • Date of Birth: __________________________________________
  • Address: _______________________________________________
  • City, State, Zip Code: ____________________________________
  • Primary Phone Number: ___________________________________

Medical Provider Information:

  • Physician's Name: ________________________________________
  • Medical Facility: ________________________________________
  • Address: ________________________________________________
  • City, State, Zip Code: ____________________________________
  • Phone Number: __________________________________________

The undersigned (patient or authorized representative) acknowledges their understanding that this DNR Order directs emergency personnel and healthcare providers to withhold cardiopulmonary resuscitation (CPR) in the event the patient's breathing or heart stops. Other medical interventions, apart from CPR, will be provided unless specified through other legal documents or directives.

Declaration:

I, _________________________________________, understand the nature and purpose of this Do Not Resuscitate Order and the potential consequences of this decision. I affirm this choice is made voluntarily and without coercion. This decision does not affect the provision of other life-prolonging measures unless otherwise specified in additional healthcare directives.

Patient/Representative Signature:

  • Signature: ___________________________________________
  • Date: ________________________________________________
  • Relationship to Patient (if not the patient): ____________________

Physician's Statement and Signature:

I, _________________________________________, a licensed physician in the State of Missouri, affirm that I have discussed the nature and purpose of the Do Not Resuscitate Order with the patient or their authorized representative. I certify that this decision has been made voluntarily and with full understanding of the potential consequences.

  • Physician's Signature: _____________________________________
  • Date: ___________________________________________________
  • License Number: _________________________________________

Form Details

Fact Name Description
Definition The Missouri Do Not Resuscitate (DNR) Order is a legal document that indicates a person's wish not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Governing Law The Missouri DNR Order is governed by Missouri Revised Statutes, Section 197.220.
Eligibility Any adult may complete a DNR order, and it can also be completed on behalf of a minor by a parent or legal guardian.
Signature Requirement The DNR order must be signed by the patient or their authorized representative, as well as a physician.
Form Availability The Missouri DNR Order form is available online and can be printed for use.
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 personnel are required to honor a valid DNR order in the event of a medical emergency.
Notification It is advisable to inform family members and healthcare providers about the existence of a DNR order.
Storage The DNR order should be kept in an easily accessible location, such as on the refrigerator or with medical records.
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