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Fillable Kansas Do Not Resuscitate Order Form

A Kansas Do Not Resuscitate (DNR) Order form 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 not to receive life-saving measures. Understanding this important document can provide peace of mind during difficult times; consider filling out the form by clicking the button below.

In Kansas, the Do Not Resuscitate (DNR) Order form serves as a vital document for individuals who wish to express their preferences regarding medical treatment in emergency situations. This form allows patients to indicate that they do not want resuscitation efforts, such as chest compressions or intubation, if their heart stops or they stop breathing. It is essential for patients to discuss their wishes with healthcare providers and loved ones to ensure that their decisions are understood and respected. The DNR form must be completed and signed by a physician, reinforcing its legitimacy and ensuring that medical personnel will follow the patient’s wishes. Additionally, the form must be readily available to emergency responders, as it guides them in making critical decisions during life-threatening situations. Understanding the implications of this document can provide peace of mind for both patients and their families, knowing that their healthcare choices will be honored even when they cannot communicate them directly.

Kansas Do Not Resuscitate Order - Usage Instruction

Filling out the Kansas Do Not Resuscitate Order form is an important step in expressing your healthcare wishes. Once you complete the form, it should be shared with your healthcare provider and kept in a place where it can be easily accessed in case of a medical emergency.

Obtain the Kansas Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
Read the instructions carefully. Make sure you understand what each section requires.
Fill in your personal information. This typically includes your name, address, and date of birth.
Designate a person to make decisions on your behalf if you are unable to do so. Provide their contact information.
Clearly state your wishes regarding resuscitation. Indicate whether you want to be resuscitated or not.
Sign and date the form. Ensure that your signature is clear and legible.
Have the form witnessed. In Kansas, you may need to have one or two witnesses sign the form, depending on the requirements.
Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and designated decision-maker.

Dos and Don'ts

When filling out the Kansas Do Not Resuscitate Order form, it is important to follow certain guidelines to ensure that your wishes are clearly communicated. Below is a list of things you should and shouldn't do:

Do: Read the entire form carefully before starting.
Do: Ensure that the form is completed in ink to avoid any issues with legibility.
Do: Provide all required information, including patient identification and signature.
Do: Discuss your wishes with your healthcare provider to ensure understanding.
Do: Keep a copy of the completed form for your records.
Don't: Leave any required fields blank, as this may invalidate the form.
Don't: Use white-out or any other method to alter the form; changes should be initialed.
Don't: Sign the form without fully understanding its implications.
Don't: Assume that verbal instructions will be sufficient; written documentation is necessary.
Don't: Forget to inform family members and caregivers about the existence of the form.

Document Overview

Fact Name	Details
Definition	A 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 Kansas Do Not Resuscitate Order is governed by K.S.A. 65-4942 and K.S.A. 65-4943.
Eligibility	Any adult who is capable of making informed decisions about their medical care can complete a DNR Order.
Signature Requirement	The DNR Order must be signed by the patient or their legal representative to be valid.
Healthcare Provider's Role	Healthcare providers must honor a valid DNR Order and cannot perform CPR if it is in place.
Form Availability	The Kansas DNR Order form can be obtained from healthcare providers, hospitals, or online through state health department resources.
Revocation	A DNR Order can be revoked at any time by the patient or their legal representative, verbally or in writing.
Emergency Medical Services	Emergency Medical Services (EMS) personnel are required to follow the DNR Order in the field.
Patient Autonomy	The DNR Order supports patient autonomy, allowing individuals to make decisions regarding their end-of-life care.
Documentation	It is crucial to keep the DNR Order accessible and to inform family members and healthcare providers of its existence.

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Preview - Kansas Do Not Resuscitate Order Form

Kansas Do Not Resuscitate Order (DNR)

This document serves as a Do Not Resuscitate Order in accordance with Kansas state laws related to advance directives and medical care.

Patient Information:

Full Name: _______________________________
Date of Birth: _______________________________
Address: _______________________________
City, State, Zip: _______________________________

Physician Information:

Full Name: _______________________________
Contact Number: _______________________________

This Do Not Resuscitate Order expresses the patient’s wishes regarding resuscitative measures in the event of cardiac arrest or respiratory failure.

Patient’s Decision: The patient has chosen to receive comfort measures only and does not wish to have cardiopulmonary resuscitation (CPR) or other life-sustaining treatments initiated.

Signature of Patient or Authorized Decision Maker:

_______________________________

(If the patient is unable to sign, an authorized decision maker must sign.)

Witnesses:

Two witnesses are required for this DNR to be valid.

Witness 1: _______________________________
Signature: _______________________________
Date: _______________________________

Witness 2: _______________________________
Signature: _______________________________
Date: _______________________________

This document should be kept in a location accessible to healthcare providers and family members. A copy of this order should be provided to your primary care physician and any hospitals where you may receive care.

End of Document

➤ Do Not Resuscitate Order PDF Form

Misconceptions

There are several misconceptions surrounding the Kansas Do Not Resuscitate (DNR) Order form. Understanding these can help clarify its purpose and use.

A DNR order means no medical care at all. This is incorrect. A DNR order specifically addresses resuscitation efforts in the event of cardiac arrest. Other medical treatments can still be provided.
Only terminally ill patients can have a DNR order. This is a misconception. Any individual, regardless of their health status, can request a DNR order if they wish to forgo resuscitation.
A DNR order is permanent and cannot be changed. This is not true. A DNR order can be revoked or modified at any time by the individual or their authorized representative.
Healthcare providers must follow a DNR order without question. While healthcare providers are generally required to respect a DNR order, they also have a duty to ensure that the order is valid and properly documented.
A DNR order is the same as a living will. This is a common misunderstanding. A DNR order specifically pertains to resuscitation efforts, while a living will covers a broader range of medical decisions regarding end-of-life care.

Documents used along the form

The Kansas Do Not Resuscitate (DNR) Order form is a crucial document for individuals who wish to express their preferences regarding resuscitation efforts in the event of a medical emergency. However, several other forms and documents often accompany this order to ensure that a person's healthcare wishes are respected and clearly communicated. Below is a list of these important documents.

Advance Directive: This document outlines an individual's preferences for medical treatment and appoints a healthcare proxy to make decisions on their behalf if they become unable to do so.
Boat Bill of Sale: A legal document used to record the transfer of ownership of a boat, essential for protecting both parties in the transaction. For more information, visit Top Forms Online.
Living Will: A type of advance directive that specifically addresses an individual's wishes regarding end-of-life care and medical interventions.
Healthcare Power of Attorney: This legal document designates someone to make healthcare decisions for an individual if they are incapacitated.
Physician Orders for Life-Sustaining Treatment (POLST): A medical order that outlines a patient's preferences for life-sustaining treatments, designed for those with serious illnesses.
Do Not Intubate (DNI) Order: Similar to a DNR, this order specifically prohibits the use of intubation to assist with breathing.
Organ Donation Consent: A document indicating an individual's wishes regarding organ donation after death, which can be included in advance directives.
Medical History Form: A comprehensive record of an individual's past medical conditions, treatments, and allergies, which aids healthcare providers in making informed decisions.
Emergency Medical Services (EMS) Form: A document that informs emergency responders of a person's DNR status and other critical medical information.
Patient Information Sheet: A summary of a patient’s medical needs and preferences, often used for quick reference by healthcare providers.

These documents work together to create a clear and comprehensive plan for medical care. Understanding and utilizing them can significantly ease the burden on family members and healthcare providers during critical moments.