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In the state of Minnesota, individuals have the right to make decisions about their healthcare, especially concerning measures taken at the end of life. A critical tool in ensuring these preferences are respected is the Do Not Resuscitate (DNR) Order form. This legal document allows a person to express their wish not to have cardiopulmonary resuscitation (CPR) in the event their heart stops or they stop breathing. The DNR Order is vital for those who want to avoid aggressive life-saving interventions that might not align with their wishes for comfort and quality of life during their final moments. Healthcare professionals are legally required to adhere to the directives outlined in a valid DNR Order, making it a powerful advocate for patient autonomy. The form itself must be filled out carefully and requires specific information to be legally binding, including signatures from the individual (or their legal healthcare agent) and a licensed healthcare provider. Understanding the nuances of the DNR Order, how to complete it, and how it integrates with other advance directives can provide peace of mind for individuals and their families, ensuring that their healthcare preferences are respected and followed.

Minnesota Do Not Resuscitate Order Example

Minnesota Do Not Resuscitate (DNR) Order

This Minnesota Do Not Resuscitate (DNR) Order template is designed to provide necessary information for the creation of an effective DNR order, in compliance with relevant Minnesota state laws, including the Minnesota Patient’s Bill of Rights. By completing and signing this form, the individual, or their legally authorized representative, directs medical professionals to withhold resuscitation measures in the event of cardiac or respiratory arrest.

Complete the following information:

Patient's Full Name: _________________________________________________

Date of Birth: ________________________________________________________

Address: ______________________________________________________________

Primary Physician's Name: _____________________________________________

Physician's Contact Information: ________________________________________

Do Not Resuscitate Order

I, _________________________, understand the full implications of this Do Not Resuscitate Order. I have discussed my wishes with my physician and understand that this request will guide my medical team’s actions in the event that my breathing or heart stops. This order is based on my rights under the Minnesota Patient’s Bill of Rights and my personal wishes.

Date: _________________________

Signature of Patient or Legally Authorized Representative: ___________________

If signed by a legally authorized representative, indicate relationship to patient: ________________________

Physician's Statement

I, _________________________, a licensed physician in the state of Minnesota, attest that the individual named above has fully discussed their wishes regarding resuscitation with me. I have advised the individual of the nature, consequences, and risks of this decision, and certify that this Do Not Resuscitate Order reflects those wishes.

Date: _________________________

Signature of Physician: ____________________________

License Number: ____________________________

Contact Information for Immediate Family or Legal Representative

Please provide contact information for a family member or legal representative to be contacted in case of an emergency.

Name: _____________________________________________________

Relationship to Patient: _____________________________________

Contact Number: ____________________________________________

Additional Instructions (if any)

_____________________________________________________________________

_____________________________________________________________________

Form Specifications

Fact Description
Definition A Minnesota Do Not Resuscitate (DNR) Order is a legal document that informs medical personnel not to perform CPR (cardiopulmonary resuscitation) on a patient if their breathing stops or if their heart stops beating.
Governing Law In Minnesota, Do Not Resuscitate Orders are governed by the Minnesota Statutes, specifically sections related to patient rights and emergency medical services.
Who Can Request The request for a DNR Order can be made by a patient who is of sound mind and capable of making their own healthcare decisions or by a legal healthcare proxy or guardian if the patient is incapacitated or otherwise unable to communicate their healthcare preferences.
Form Necessity Although a formal DNR Order form is used to document a patient's wishes, the law also recognizes the validity of verbal orders given directly to healthcare providers in some circumstances.
Scope of Application A DNR Order applies to situations involving cardiac or respiratory arrest and does not affect other forms of medical treatment that a patient may receive. The order is intended for use in both hospital settings and by emergency responders in the community.

Steps to Writing Minnesota Do Not Resuscitate Order

When navigating the complexities of healthcare and end-of-life decisions, the Minnesota Do Not Resuscitate (DNR) Order form is a critical document for those choosing not to receive CPR (Cardiopulmonary Resuscitation) in the event their heart stops or they stop breathing. This document is a means of communicating these wishes formally and requires careful completion to ensure that healthcare providers understand and respect the individual's choices. The following instructions guide you through the process of accurately filling out the Minnesota DNR Order form.

  1. Start by entering the patient's full legal name at the top of the form. This ensures that the document is correctly associated with the individual it concerns.
  2. Fill in the patient's date of birth, using the format MM/DD/YYYY, to provide clear identification and avoid any confusion with individuals of a similar name.
  3. Enter the patient's address, including street, city, state, and zip code, to provide further identification and to indicate where the individual resides.
  4. Indicate the patient's sex by checking the appropriate box. This information helps in further identifying the patient.
  5. Provide the name and contact information of the patient's primary physician. This includes the physician’s full name, phone number, and fax number, if available, to enable easy communication and verification of the DNR order.
  6. If the patient has a health care agent appointed under a healthcare directive, enter the agent’s name and contact information. This ensures that the agent’s authority is recognized and that they can be contacted if needed.
  7. Next, if applicable, detail any specific conditions under which the DNR order should apply. This portion allows for personalized directives regarding when the DNR order should be enacted.
  8. The patient or the patient’s legally recognized healthcare agent must sign and date the form. This signature is the most critical step as it demonstrates the consent to the DNR order.
  9. A witness must also sign and date the form, verifying the patient’s or the healthcare agent’s signature. This step is essential for the document's legality and to ensure the directive is voluntarily chosen.
  10. Lastly, the patient’s physician must sign and date the form, confirming the medical advisability of the DNR order. The physician's signature indicates professional agreement and understanding of the patient’s wishes.

Once completed, it’s important to keep the Minnesota DNR Order form where it can be quickly and easily accessed by healthcare providers, such as in the patient’s home or among personal records if not residing in a healthcare facility. Additionally, consider informing close family members, caregivers, or health proxies of the document's location and existence to ensure that the patient’s wishes are honored without delay in an emergency.

Listed Questions and Answers

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

    A Do Not Resuscitate (DNR) order in Minnesota is a legal document that instructs medical professionals not to perform cardiopulmonary resuscitation (CPR) if an individual's heart stops beating or if they stop breathing. This order is used by people who have serious illnesses or are at the end of their life and wish to avoid aggressive life-saving measures. The order must be signed by both the individual and their healthcare provider.

  2. How can someone obtain a DNR order in Minnesota?

    Obtaining a DNR order in Minnesota involves several steps. Firstly, the individual or their healthcare proxy should discuss their wishes with their healthcare provider. If a DNR order is considered appropriate, the healthcare provider will prepare the order. It is crucial for the individual or the proxy to ensure that the order accurately reflects their wishes. After being signed by both parties, the DNR order should be kept in an easily accessible place and shared with relevant family members and healthcare providers.

  3. Who should be informed about an individual's DNR order?

    • Family members or close friends
    • The individual's healthcare proxy or power of attorney, if one has been appointed
    • Primary healthcare providers and specialists involved in the individual's care
    • Hospital staff if the individual is admitted to a hospital
    • Home care agencies or nursing home staff if the individual receives care in these settings

    Informing these people ensures that the individual's wishes are respected across different care settings.

  4. Can a DNR order be cancelled or changed in Minnesota?

    Yes, a DNR order can be cancelled or changed in Minnesota at any time by the individual who created it or their legal healthcare proxy. To cancel or modify the order, the individual should communicate their new wishes to their healthcare provider, who will then revise or completely cancel the DNR order as requested. It is important to also communicate any changes to family members and other healthcare providers to ensure that the individual's current wishes are known and can be followed.

Common mistakes

In the state of Minnesota, accurately completing a Do Not Resuscitate (DNR) Order form is paramount for those wishing to have their desires regarding resuscitation respected during medical emergencies. Unfortunately, several common mistakes can significantly impair the effectiveness of these directives. Below are seven errors frequently made when filling out this crucial document:

  1. Failing to consult with a healthcare provider - Before completing a DNR form, it's important to discuss one's choices and the implications with a qualified healthcare practitioner to ensure the document reflects the individual's desires accurately and is appropriately integrated into their medical plan.

  2. Not using the proper form - The state of Minnesota may require a specific format for DNR orders to be recognized. Using an incorrect or outdated form could render the directive invalid.

  3. Leaving blank spaces - Every field in the DNR form should be filled out completely. Unanswered questions or blank spaces may lead to confusion or misinterpretation of the patient's wishes.

  4. Misunderstanding the terms - DNR forms contain medical terminology that may not be familiar to all. Misinterpretations of these terms can result in the document not accurately reflecting the individual's intentions.

  5. Incorrect signatures - A DNR order typically needs to be signed by the person the order is for (as long as they are of sound mind to do so) and possibly also by the healthcare provider. Missing or incorrect signatures can invalidate the form.

  6. Failure to inform family members and caregivers - It's crucial that family members and caregivers are aware of and understand the DNR order. Not communicating these wishes can lead to delays or disputes about the chosen measures during an emergency.

  7. Not reviewing and updating - As circumstances and views change, it's important to review and, if necessary, update the DNR order. An outdated DNR may not reflect the current wishes of the individual.

To ensure that a DNR order accurately communicates one's wishes, careful attention to detail is required. The above mistakes are preventable and addressing them can significantly impact the effectiveness and clarity of the document. Consulting with legal and medical professionals can provide guidance and peace of mind that one's wishes will be respected.

Documents used along the form

When preparing for end-of-life decisions, particularly in Minnesota, the Do Not Resuscitate (DNR) Order form is often accompanied by several other important documents. Each document plays a critical role in ensuring an individual’s healthcare wishes are known and respected. Understanding these documents can be invaluable for those looking to complete their end-of-life planning. Below are four documents commonly used alongside the Minnesota DNR Order form.

  • Healthcare Directive: This legal document allows an individual to outline their healthcare preferences, including decisions about life-sustaining treatments, if they are unable to communicate their wishes themselves. It can appoint a healthcare agent to make decisions on their behalf, ensuring their healthcare wishes are followed.
  • Power of Attorney for Healthcare: This appoints a specific person, known as an agent, to make healthcare decisions for the individual if they become incapable of making such decisions. Unlike a healthcare directive, it may not include specific instructions about the individual's healthcare preferences.
  • Living Will: A living will is similar to a healthcare directive but is more focused on end-of-life care. It outlines which treatments an individual wants or does not want if they are terminally ill or permanently unconscious, making their wishes clear in case they can't communicate.
  • POLST (Provider Orders for Life-Sustaining Treatment): This medical order form is for seriously ill individuals and details what types of life-sustaining treatment they want or do not want. It is designed to be easily accessible to healthcare providers, ensuring that an individual's end-of-life care preferences are respected and followed across different settings.

Together with the Minnesota DNR Order, these documents form a comprehensive plan for end-of-life care. They ensure that an individual's healthcare wishes are clearly communicated and legally documented, providing peace of mind for both the individual and their loved ones. It is advisable for individuals to discuss these options with healthcare providers and legal professionals to ensure that their wishes are properly understood and recorded.

Similar forms

The Minnesota Do Not Resuscitate (DNR) Order shares similarities with an Advance Health Care Directive (AHCD). Both documents give individuals control over their health care decisions, with the AHCD specifying a person's health care preferences in various situations, not limited to resuscitation. This directive may contain a DNR order as part of its instructions, making the two documents complementary in ensuring a person's healthcare wishes are respected.

Comparable to a DNR, the Medical Power of Attorney (MPA) designates someone to make health care decisions on behalf of another individual if they become unable to do so themselves. While the DNR is specifically about resuscitation preferences, the MPA covers a broader range of medical decisions, reflecting the trust and authority given to the appointed agent to act in the best interest of the person.

The POLST (Physician Orders for Life-Sustaining Treatment) form is another document resembling a DNR order. It is designed for individuals with serious illnesses or at the end of life and outlines a plan for various life-sustaining treatments, including resuscitation. The POLST form turns specific medical treatment wishes into actionable medical orders, making it more immediately actionable than a typical DNR.

A Living Will is akin to the Minnesota DNR order in that it documents a person's preferences about medical treatments at the end of life. Unlike a DNR, which is specifically about resuscitation, a Living Will can include a wide range of end-of-life care preferences, such as the use of ventilators or tube feeding, providing broader directives for scenarios where an individual is incapacitated.

Organ Donor Registration forms also share a connection with DNR orders. They allow individuals to make decisions about their bodies after death, focusing on the donation of organs and tissues. Both documents respect an individual's wishes regarding their body, with organ donation choices often included in broader end-of-life planning discussions where DNR preferences are expressed.

The Five Wishes document is another comprehensive plan that includes aspects similar to a DNR. It covers personal, emotional, and spiritual needs in addition to medical wishes such as resuscitation. This broader approach to end-of-life planning makes it a tool for expressing care preferences in a more holistic way, although it incorporates elements of a DNR within its framework.

HIPAA Release Forms, while primarily focused on the privacy and dissemination of health information, have a link to DNR orders through the aspect of sharing crucial medical information. By specifying who can receive medical information about a patient, these forms can ensure that a person’s DNR orders are communicated effectively to healthcare professionals and family members, thus supporting the patient’s health care decisions.

Lastly, the Do Not Intubate (DNI) order is closely related to the DNR. It specifically prohibits the use of intubation to keep someone breathing. Like a DNR, a DNI is crucial for patients who wish to avoid certain life-sustaining measures. Though it focuses on a different aspect of emergency care, it shares the core principle of specifying medical interventions an individual wishes to avoid.

Dos and Don'ts

When filling out the Minnesota Do Not Resuscitate (DNR) Order form, it's essential to approach it with care. This document is critical for ensuring your wishes are honored in life-threatening situations. The following are guidelines to help guide you through the process:

  • Do review the form with a healthcare professional. It's crucial to fully understand the implications of a DNR order and how it affects emergency medical care.
  • Do ensure that all information is accurate and legible. This includes verifying personal information, such as your full name and date of birth, to avoid any confusion during emergencies.
  • Do discuss your decision with close family members or guardians. This helps ensure that those closest to you understand your wishes and can support your decision during critical times.
  • Do keep the DNR order in an easily accessible place once signed. First responders need to locate the document quickly in an emergency.
  • Do inform your primary care provider and any specialists involved in your care about your DNR order. It can be added to your medical records for consistency in your care decisions.
  • Don’t leave sections of the form blank. If a section does not apply to you, indicate this appropriately rather than ignoring it.
  • Don’t attempt to modify the form’s wording without legal advice. Alterations could invalidate the document or cause misunderstandings about your wishes.
  • Don’t forget to renew or review the order as necessary. Your health status and preferences may change, and it is important to ensure the DNR order reflects your current wishes.
  • Don’t sign the form without witnessing by appropriate parties as required. Witnesses or notarization may be necessary to ensure the document’s legal validity.

By following these guidelines, you can ensure that your Minnesota Do Not Resuscitate Order accurately reflects your healthcare wishes and is recognized and respected in critical situations.

Misconceptions

When it comes to a Do Not Resuscitate Order (DNR) in Minnesota, there are several misconceptions that can cause confusion. Understanding what a DNR order is, and what it is not, is crucial for making informed health care decisions.

  • Only the elderly need a DNR order. A DNR order is not limited to elderly individuals. It can be relevant for people of any age facing serious health issues where resuscitation would not align with their wishes or best interests.

  • Having a DNR means you get no medical treatment. This is a common misconception. A DNR order specifically refers to not using CPR (cardiopulmonary resuscitation) if your heart stops or if you stop breathing. It does not mean refusing other types of medical care or treatments.

  • A DNR order can only be set up by a doctor. While a doctor or healthcare provider must approve and sign a DNR order, the initiation can come from the patient or their healthcare proxy, reflecting the patient's wishes regarding life-saving measures.

  • Emergency responders will always follow a DNR order. In reality, for a DNR order to be followed, it must be readily available and presented to the emergency personnel upon their arrival. If it is not visible or available, they are obligated to proceed with resuscitation efforts.

  • Once a DNR order is in place, it cannot be changed. People often think a DNR is permanent once established. However, a patient or their legally authorized representative can modify or revoke a DNR order at any time if they change their mind about their care preferences.

Key takeaways

Completing the Minnesota Do Not Resuscitate (DNR) Order form involves several important considerations to ensure that an individual's wishes regarding resuscitation are clearly documented and respected by healthcare professionals. The document is crucial for those who wish to decline resuscitation attempts in the event of cardiac or respiratory arrest. Here are four key takeaways to understand when filling out and utilizing the Minnesota DNR Order form:

  • The individual or their legally authorized representative must clearly understand what a DNR order implies, including that in life-threatening situations, CPR will not be initiated.
  • It's essential to complete the form accurately, providing all required information such as the individual's full name, date of birth, and specific medical orders about the DNR request. Documentation must be completed by a licensed healthcare provider to be valid.
  • The DNR order must be readily accessible to healthcare workers in an emergency. This means keeping the document in an easily accessible place and informing family members or caregivers of its existence and location.
  • People should discuss their wishes with family members, caregivers, and healthcare providers to ensure their choices are understood and can be honored in the event of an emergency.

Understanding and following these key points can help ensure that the Minnesota DNR Order form effectively communicates an individual's wishes regarding resuscitation, providing peace of mind to all involved.

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