Printable Do Not Resuscitate Order Form for Wisconsin

Guidelines on Utilizing Wisconsin Do Not Resuscitate Order

In Wisconsin, the Do Not Resuscitate (DNR) order is a crucial legal document for individuals wishing to decline resuscitation in the event of a cardiac or respiratory arrest. This decision is personal and significant, ensuring a person's healthcare preferences are respected during emergency situations. The process for completing a DNR order involves clear steps, ensuring the wishes of the individual are documented accurately and legally. Below is a step-by-step guide designed to assist in filling out the Wisconsin DNR order form properly.

1. Begin by collecting all necessary information, including full legal name, date of birth, and address. This information will ensure the form is matched correctly to your healthcare records.
2. Consult with your primary care physician or a healthcare provider authorized to sign off on DNR orders in Wisconsin. This conversation is crucial, as it involves discussing the implications of a DNR order and ensuring it aligns with your healthcare goals.
3. Fill out the patient section of the DNR order form with your personal information, ensuring no detail is omitted. Accuracy here is vital for the effectiveness of the document.
4. Review the form with your healthcare provider, who will need to complete the portion of the form designated for medical professionals. Their signature is essential for the form’s validity.
5. Ensure any designated healthcare power of attorney or legal guardian also reviews and acknowledges the DNR order, if applicable. Their understanding and agreement may be necessary, depending on your medical and legal situation.
6. Complete the form by signing and dating it in the presence of a witness, who must also sign. The witness verifies your identity and confirms the voluntary nature of the decision.
7. File the completed form with your healthcare provider, and keep a copy for your personal records. It's also advisable to inform close family members or caregivers of the DNR order to ensure your wishes are known and can be easily accessed in an emergency.

Once these steps are completed, your DNR order will be active. It’s important to review this document periodically and after any significant health changes. Remember, a DNR order can be revoked at any time by the individual it pertains to, ensuring that one's current healthcare preferences are always honored. Coordination with healthcare providers is key to ensure the document remains valid and is accessible when needed.

What is a Do Not Resuscitate (DNR) Order in Wisconsin?

A Do Not Resuscitate (DNR) Order in Wisconsin is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event that a patient's breathing stops or their heart ceases to beat. This order is made by a patient or their legal representative when they wish to avoid aggressive interventions that are unlikely to provide a meaningful benefit in the context of their overall health.

Who can request a DNR Order in Wisconsin?

In Wisconsin, a DNR Order can be requested by an adult patient who is of sound mind, a legally appointed guardian, or a healthcare power of attorney on behalf of the patient. The decision to request a DNR Order should be made after careful consideration and discussion with a healthcare provider about the patient's medical condition and prognosis.

How can one obtain a DNR Order in Wisconsin?

To obtain a DNR Order in Wisconsin, the patient or their authorized representative needs to discuss their wishes with a healthcare provider. The healthcare provider will then review the patient's medical condition and prognosis to ensure that a DNR Order is appropriate. If it is deemed appropriate, the healthcare provider will fill out the necessary DNR form. The form must be signed by the healthcare provider and the patient or their authorized representative.

Is the Wisconsin DNR Order applicable in all settings?

The Wisconsin DNR Order is applicable in most settings, including hospitals, nursing homes, and in the patient's home. However, it's important to communicate the existence of the DNR Order to all healthcare providers and ensure that a copy of the order is readily available in all care settings to ensure it is honored.

Can a DNR Order be revoked?

Yes, a DNR Order in Wisconsin can be revoked at any time by the patient or their authorized representative. Revocation can be done verbally or in writing. If the revocation is verbal, it is advisable to follow up with a written document and notify all healthcare providers who have a copy of the DNR Order.

What if a patient is unable to communicate and doesn't have a DNR Order?

If a patient is unable to communicate their wishes regarding resuscitation and does not have a DNR Order in place, healthcare providers will generally proceed with all available emergency treatments, including CPR, in accordance with Wisconsin law and medical ethics. This highlights the importance of discussing end-of-life wishes and possibly establishing a DNR Order when the patient is able to do so.

Does the family's opinion matter if there is a DNR Order in place?

If a DNR Order is in place, it reflects the patient's wishes regarding CPR and emergency treatments. While family members' opinions and emotional stress are understood and respected, healthcare providers are bound to follow the instructions outlined in the DNR Order. Family members can discuss concerns with the healthcare team, but the final decision rests on the documented wishes of the patient.

Are there legal consequences for healthcare providers who do not honor a DNR Order in Wisconsin?

Healthcare providers in Wisconsin are legally required to comply with a valid DNR Order. Failure to honor a DNR Order without a legitimate medical or legal reason could result in disciplinary action against the healthcare provider, as well as potential legal consequences. It is vital for healthcare providers to review and understand the contents of a DNR Order and to take appropriate action in accordance with the patient's wishes.

When completing the Wisconsin Do Not Resuscitate (DNR) Order form, people often make several common mistakes. It is crucial to navigate this process with care to ensure that the document accurately reflects the person's wishes and is legally valid. Below are six frequent errors people make with this form:

1. Not consulting with a healthcare provider before completing the form. The DNR order is a legal document that requires specific medical criteria to be met. It must be signed by a licensed healthcare professional to be valid. Individuals sometimes fill out the form without the necessary medical input, rendering it ineffective.

2. Incorrectly filling out personal information. The form requires precise details, including the individual's full legal name, date of birth, and other identifying information. Mistakes in this section can lead to confusion and potentially make the document invalid.

3. Failing to discuss wishes with family members or caregivers. The decision to have a DNR order should ideally be communicated with close family members or caregivers to ensure they understand the person's choices. Not having these discussions can lead to distress and conflict during emergencies.

4. Omitting the signature and date. Both the individual's and the healthcare provider’s signatures, along with the date, must be included for the DNR order to be executed. Skipping these signatures makes the document non-compliant with state laws.

5. Not using the most current version of the form. The state of Wisconsin periodically updates the DNR order form to reflect changes in law or policy. People often use outdated versions, which may not be recognized by healthcare professionals or legal authorities.

6. Forgetting to renew the DNR order. DNR orders are not necessarily permanent and may require renewal. Individuals sometimes neglect this, assuming once the form is filled out, no further action is needed. This oversight can lead to an expired DNR order when it is needed the most.

To avoid these mistakes, individuals should:

• Consult with a healthcare provider to ensure the DNR order meets all required medical criteria and is signed appropriately.
• Fill out all personal information accurately and double-check it for errors.
• Have open discussions with family members or caregivers about their DNR wishes.
• Make sure both the individual and the healthcare provider sign and date the form, confirming it's filled out completely.
• Use the latest version of the DNR order form available from Wisconsin's Department of Health Services website.
• Keep track of the DNR order's validity and renew it as needed to ensure it remains in effect.

By being aware of and avoiding these common pitfalls, individuals can ensure that their DNR orders are correctly filled out and will be respected by healthcare providers and loved ones alike.

In Wisconsin, when a person decides not to undergo CPR (Cardiopulmonary Resuscitation) in the event of cardiac or respiratory arrest, they may fill out a Do Not Resuscitate (DNR) Order form. This form is just one piece of a larger puzzle regarding end-of-life planning and care preferences. Accompanying this document, several other forms and documents are frequently utilized to ensure an individual’s health care and legal wishes are fully honored and understood. These documents complement the information provided by a DNR and offer a comprehensive approach to planning.

1. Advance Directive: This document allows individuals to outline their healthcare preferences, including decisions beyond resuscitation. It typically includes a living will and health care power of attorney, specifying what types of medical treatments or life-sustaining measures a person wants or does not want.
2. Living Will: A living will is a type of advance directive where one can express their wishes regarding end-of-life medical care, should they become unable to communicate their preferences themselves. It goes into specifics about different medical interventions.
3. Health Care Power of Attorney: This legal form enables a person to designate another individual (an agent) to make health care decisions on their behalf if they are unable to do so. This document can include preferences about accepting or refusing treatment, including a DNR order.
4. POLST (Physician Orders for Life-Sustaining Treatment): A POLST form translates a person’s preferences into medical orders to be followed by health care providers. It covers a broader range of instructions than a DNR, including preferences for intubation, hospitalization, antibiotics, and more.
5. Organ and Tissue Donation Consent Form: For those interested in organ or tissue donation after death, this form records that consent. It is a critical component for ensuring that their wishes are respected and can be part of end-of-life planning discussions.
6. Will and Testament: Although not directly related to healthcare decisions, a will is crucial for end-of-life planning. It outlines how a person’s property and affairs should be handled after their death. Having a will in place can alleviate significant stress and confusion for surviving family members.

Each of these documents plays a vital role in ensuring that individuals have control over their healthcare and personal decisions. Together with a Do Not Resuscitate Order, they form a comprehensive plan that respects the individual’s wishes during critical times, ensuring those wishes are known and can be legally enforced. Planning ahead with these documents can provide peace of mind to both the individuals and their families, making difficult decisions easier to manage during stressful times.

The Wisconsin Do Not Resuscitate (DNR) Order form shares similarities with a Living Will, as both documents guide medical decision-making when a person is unable to make those decisions themselves. A Living Will describes a person's wishes regarding medical treatment in scenarios where they are incapacitated or terminally ill, similar to how a DNR order specifies the wish not to have CPR performed in the event of cardiac or respiratory arrest. Both are proactive measures to control one's medical care.

Another document related to the Wisconsin DNR order is the Medical Power of Attorney (POA). This document appoints someone to make healthcare decisions on behalf of someone else, should they become unable to do so. Like the DNR, the Medical POA addresses decision-making in serious health situations, but it is broader, covering a range of medical decisions beyond resuscitation.

The POLST (Physician Orders for Life-Sustaining Treatment) form also shares a purpose with the DNR order. It is designed for seriously ill or frail patients and outlines a plan of care, including the patient's wishes about treatments such as intubation or CPR. Both documents communicate critical end-of-life care preferences directly to healthcare professionals, ensuring that the patient's wishes are followed.

Advance Directives combine the aspects of Living Wills and Medical POA, providing comprehensive instructions for future healthcare and naming a healthcare proxy. Like the DNR, Advance Directives are prepared ahead of time and come into play when the individual is unable to communicate their wishes, ensuring their healthcare preferences are respected.

The Five Wishes document offers a broader approach to discussing and documenting one's end-of-life care preferences, covering personal, spiritual, and emotional wishes in addition to medical wishes like those in a DNR. It acts as a conversation starter among family, friends, and healthcare providers about one’s values and desires for end-of-life care.

A Hospital Do Not Resuscitate (HDNR) order, specific to hospital settings, is similar to the Wisconsin DNR in its function but is executed within the hospital by a physician. The HDNR directly informs medical staff within a hospital or clinical setting not to perform CPR, echoing the intent of the DNR but within a more limited context.

The Durable Power of Attorney for Health Care is closely related to the Medical POA and impacts decisions about healthcare when one cannot make those decisions themselves. It allows the designated agent to make a broad range of healthcare decisions, which can include the implementation or refusal of a DNR order, tying the patient’s comprehensive care wishes under one representative.

An Emergency Medical Services (EMS) DNR form is designed specifically for emergency medical personnel, similar to the Wisconsin DNR order. However, it is tailored to prevent the initiation of CPR by EMS providers before the hospital. Its specificity to pre-hospital settings complements the broader scope of a state-recognized DNR order.

A Health Care Proxy is a document that, like a Medical POA, allows an individual to designate another person to make healthcare decisions on their behalf. It comes into effect when the individual is unable to make their own decisions. The connection to a DNR order lies in the authority given to the proxy to enforce or decide upon the DNR status based on previously communicated wishes of the individual.

Lastly, the Mental Health Advance Directive outlines preferences for treatment during a mental health crisis, similar to how a DNR indicates preferences for physical health crises. Though focusing on mental health, it parallels the DNR's objective of guiding healthcare providers in accordance with the individual's wishes when they cannot express those wishes themselves.

Filling out a Wisconsin Do Not Resuscitate (DNR) Order form requires careful consideration and understanding of its implications. A DNR order informs medical personnel not to perform CPR if your heart stops or if you stop breathing. Here are essential dos and don'ts to guide you through the process:

• Do discuss your decision with your doctor or healthcare provider before initiating a DNR order. It's crucial to grasp the medical aspects and consequences of your choice.
• Do ensure that your personal information is filled out accurately on the form. This includes your full name, date of birth, and any other identifying details required.
• Do have the form signed by your physician. A DNR order is not valid unless it's signed by a licensed healthcare professional acknowledging your decision.
• Do discuss your DNR order with close family members or legal representatives. It's important they understand your wishes and the reasons behind your decision.
• Do keep the original copy of the DNR order in an easily accessible place at home, and consider carrying a wallet-sized version with you.

• Don't fill out the form in isolation. Making a decision regarding a DNR order should involve conversation with healthcare professionals and loved ones.
• Don't omit any required signatures, including your own. Every designated spot on the form for a signature holds importance for the document's legality and enforceability.
• Don't forget to review and update your DNR order as necessary. Situations and preferences can change, so it’s wise to reassess your DNR order periodically.
• Don't hesitate to ask for help or clarification from your healthcare provider if any part of the form is unclear. Ensuring you fully understand your DNR order is crucial.

When discussing the Wisconsin Do Not Resuscitate (DNR) Order form, many people hold onto misconceptions that can affect their decisions. Understanding these inaccuracies is crucial for making informed decisions about this sensitive topic.

• Anyone can sign up for a DNR order. In reality, DNR orders in Wisconsin are specifically for patients with a terminal condition or who are at risk for sudden, life-threatening deterioration. A physician must certify the patient's health condition for the DNR order to be valid.

• A DNR order means no medical treatment. This is a common misunderstanding. A Wisconsin DNR order specifically relates to not performing CPR in the event of cardiac or respiratory arrest. It does not preclude other forms of medical treatment.

• DNR orders are permanent and cannot be changed. Patients or their legally authorized representative can cancel or modify a DNR order at any time, reflecting a change in the patient's wishes or health condition.

• DNR orders from other states are always recognized in Wisconsin. While Wisconsin healthcare providers generally honor out-of-state DNR orders, there are legal and procedural differences. It's advisable to obtain a Wisconsin-specific DNR order if you are living in or moving to the state.

• Completing a DNR order is a complicated process. While it does require a physician’s certification, the process for completing a DNR order in Wisconsin is straightforward. Health care providers can offer guidance, making it easier for patients and families to navigate.

• A DNR order means emergency services will not come if called. Emergency services will still respond to calls for help. The presence of a DNR order simply informs their approach to resuscitation efforts once they assess the situation.

• Family consent is required for a DNR order to be implemented. While discussing end-of-life wishes with family is important, a competent adult can request and establish a DNR order without family consent. The key requirement is the concurrence of the patient’s physician regarding the patient's medical condition and appropriateness of a DNR order.

Wisconsin's Do Not Resuscitate (DNR) Order form is designed for patients who wish to forgo life-sustaining treatments in certain medical situations. Understanding how to properly fill out and use this form is crucial for ensuring that your health care preferences are respected. Here are eight key takeaways to guide patients and their families through this important process.

• Eligibility: Before filling out the form, ensure that the patient meets Wisconsin's criteria for a DNR order, typically involving patients with serious or terminal illnesses who do not wish to receive CPR or other life-saving procedures under specific circumstances.
• Discussion with Healthcare Providers: It's essential for patients to have a thorough discussion with their physician or healthcare provider about the implications of a DNR order and whether it aligns with their medical needs and personal values.
• Completing the Form: The DNR order form must be filled out accurately, including all required patient information, medical diagnosis, and the patient’s and physician’s signatures to validate the document legally.
• Witnesses or Notarization: Check if your form needs to be witnessed or notarized. Wisconsin’s requirements can vary, so it’s important to comply with the current legal standards to ensure the DNR order is enforceable.
• Visibility: Once completed, the DNR bracelet or necklace provided by the state should be worn by the patient at all times. This ensures that in an emergency, first responders are immediately aware of the patient’s DNR status.
• Communication with Family and Caregivers: It's vital to communicate the existence and details of the DNR order to family members and any caregivers. Clear communication can prevent confusion and ensure the patient's wishes are honored.
• Review and Updates: If a patient’s medical condition or preferences change, the DNR order should be reviewed and, if necessary, updated. Revocation of the order is possible at any time upon the patient's or legal representative's request.
• Legal and Medical Implications: Understanding the legal and medical implications of a DNR order, including how it affects the provision of other types of medical care, is crucial. A DNR order specifically addresses resuscitation and does not impact other treatments that can improve a patient’s quality of life.

By keeping these takeaways in mind, patients and their families can navigate the complexities of Wisconsin’s DNR order process more confidently, ensuring that their health care preferences are clearly understood and respected.