A Do Not Resuscitate (DNR) Order form in Arizona is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form ensures that healthcare providers respect a person's decision to forgo life-saving measures such as CPR. Understanding the implications of a DNR Order is essential for individuals and families making end-of-life care decisions.
In Arizona, the Do Not Resuscitate (DNR) Order form plays a crucial role in ensuring that individuals receive medical care aligned with their personal wishes during critical health situations. This legally binding document allows patients to express their desire not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures in the event of cardiac arrest or respiratory failure. The DNR Order must be signed by a qualified healthcare provider, confirming that the individual understands the implications of their decision. Additionally, the form requires the signature of the patient or their legal representative, emphasizing the importance of informed consent. It is vital for individuals to discuss their preferences with family members and healthcare professionals to ensure clarity and understanding. By completing this form, individuals can take control of their medical care, providing peace of mind for themselves and their loved ones during challenging times.
Arizona Do Not Resuscitate Order (DNR)
This document serves as a Do Not Resuscitate Order pursuant to the guidelines established by the Arizona Department of Health Services. It is a declaration by the undersigned individual, or their authorized legal representative, indicating the decision to forgo resuscitation attempts in the event of cardiac or respiratory arrest. This document must be completed and signed in accordance with Arizona statutes to be legally binding.
Personal Information of the Individual:
Statement of Intent:
I, ___________________________ [full name], being of sound mind and fully understanding the consequences of this decision, hereby direct that no resuscitative measures be taken to prolong my life in the event of cardiac or respiratory failure. This includes, but is not limited to, CPR (Cardiopulmonary Resuscitation), advanced airway management, and artificial ventilation.
Signature:
Physician's Statement and Signature:
The undersigned physician affirms that the individual, or their legal representative, has discussed the implications of this Do Not Resuscitate Order with me. I verify that the individual is fully informed and consents to this order.
This document should be retained by the individual and/or their legal representative and provided to healthcare providers as necessary. A copy should also be made available in the individual's medical records. It is the individual's responsibility to notify healthcare providers of this order and to present it upon request.
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