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When individuals in Arizona face serious health conditions, they are often confronted with decisions that not only impact their care but their final moments. Among these critical decisions is whether to receive life-sustaining treatments in dire circumstances. This is where the Arizona Do Not Resuscitate Order (DNR) form becomes a focal point of planning and consideration. The form itself is a legally binding document that communicates a person's wish not to undergo CPR (cardiopulmonary resuscitation) or advanced cardiac life support if their heart stops beating or they stop breathing. It is a declaration made by either the patient or their legally authorized representative, often after careful discussion with healthcare providers about the patient's health status and personal values. The implementation of this form requires adherence to specific legal and medical protocols to ensure that the wishes of the patient are respected and followed. It reflects a significant step in making one's healthcare preferences known, aiming to provide peace of mind and dignity in situations where they may not be able to communicate their desires directly. Understanding the nuances of this form, including who can sign it, under what conditions, and how it can be revoked, is crucial for anyone considering this option in Arizona.

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Arizona Do Not Resuscitate Order

This document serves as a Do Not Resuscitate Order in accordance with the specific requirements set forth by the state of Arizona. Its purpose is to inform medical professionals of the patient's wish to forego resuscitation attempts in the event of cardiac or respiratory arrest. Please ensure all information provided is accurate and complete.

Personal Information

Patient Name: ___________________________

Date of Birth: ___________________________

Address: ____________________________________________________

Medical Information

Primary Physician: ___________________________

Physician Phone Number: ___________________________

Medical Conditions: ________________________________________

Do Not Resuscitate (DNR) Order Declaration

I, ___________________________, hereby declare my decision to forgo resuscitation including cardiopulmonary resuscitation (CPR) by medical personnel or emergency services in the event my heart and/or breathing stops. This decision is informed and voluntary, and complies with the Arizona Revised Statutes.

Legal Witness

This document requires the acknowledgment of a legal witness to ensure its validity. The witness confirms that the patient signing this DNR order did so voluntarily and without coercion.

Witness Name: ___________________________

Relationship to Patient: ___________________________

Date: ___________________________

Physician Verification

As the patient's physician, I verify that the patient's decision to have a Do Not Resuscitate Order has been discussed with me and I concur with the patient's decision based on his/her current medical condition and prognosis.

Physician Name: ___________________________

Date: ___________________________

Signature: ___________________________

Instructions for Revocation

A Do Not Resuscitate Order can be revoked at any time by the patient or their legal representative. To revoke, the patient or representative must inform the treating physician or medical personnel verbally or by destroying this document.

Disclaimer

This template is provided for informational purposes only and does not constitute legal advice. Individuals are encouraged to consult with a legal professional or healthcare provider to ensure the form complies with current Arizona laws and medical guidance.

Document Details

Fact Detail
Governing Laws Arizona Revised Statutes § 36-3251
Purpose To prevent the initiation of CPR (cardiopulmonary resuscitation) in case of cardiac or respiratory arrest
Who Can Sign The document must be signed by the patient or their legally authorized representative
Witness Requirement Signature needs to be witnessed by two adults or a notary public
Form Validity Valid across the state of Arizona
Revocation The order can be revoked at any time by the patient or their representative through a written or oral statement

Instructions on Utilizing Arizona Do Not Resuscitate Order

Embarking on the journey of preparing for future healthcare decisions can be both empowering and emotionally challenging. One critical aspect of this planning involves making decisions about the types of medical interventions you wish to receive or avoid in a life-threatening situation. In Arizona, individuals have the option to express their wishes through a Do Not Resuscitate (DNR) Order. This document is a legally binding directive that tells health care professionals not to perform CPR (Cardiopulmonary Resuscitation) if your heart stops or if you stop breathing. Due to the gravity and the irreversible nature of the decisions encapsulated within it, filling out the DNR Order requires careful attention to detail and a full understanding of its implications. Follow these steps to ensure your DNR Order accurately reflects your healthcare wishes.

Steps for Filling Out the Arizona Do Not Resuscitate Order Form:

  1. Understanding the Form: Before you begin, take a moment to read the entire DNR order form thoroughly. Make sure you understand each section and its purpose. This understanding forms the foundation for the choices you are about to make.
  2. Gather Required Information: To proceed, you'll need to compile some essential information. This includes your full legal name, date of birth, and the precise medical conditions leading you to request a DNR order. If you have questions about the medical specifics, consider consulting your healthcare provider.
  3. Completing the Form: Enter your personal information in the designated areas of the DNR form. Ensure that the information is accurate and clearly legible to avoid any misunderstandings in a medical emergency.
  4. Consultation with a Healthcare Provider: Arizona law requires that your decision for a DNR order must be discussed with a healthcare provider. This conversation is crucial, as it ensures that you fully understand the medical implications of your decision and that it's documented formally in your medical records.
  5. Signature: Upon agreeing to the terms within the DNR Order, you must sign the form. In Arizona, a DNR Order also requires the signature of the healthcare provider who discussed the decision with you. The provider's signature serves as a professional acknowledgment of your decision and its inclusion in your medical records.
  6. Witness Verification: Witnessing of the signatures is an additional step required to validate the document. The witness or witnesses can confirm the identity of the signer and the voluntary nature of the signing. Be sure to review the specifics about who may or may not serve as a witness in Arizona, as state laws can vary.
  7. Distribution: Once fully executed, copies of the DNR Order should be distributed appropriately. You should keep a copy in an easily accessible place at home, and also give copies to your primary care physician, any specialists you regularly see, and a trusted family member or friend. This ensures that your wishes are known and can be easily referenced when necessary.

Creating a legal directive, such as a Do Not Resuscitate Order, is a profound step in healthcare planning. It communicates your wishes clearly to family members and healthcare professionals, potentially easing decision-making burdens during critical times. As with any significant legal or medical decision, consider seeking advice from healthcare professionals and legal experts to ensure your choices are informed and aligned with current Arizona laws. Remember, the steps outlined above are merely a guide. The actual process can be more nuanced, reflecting personal circumstances and evolving legal requirements.

Listed Questions and Answers

What is an Arizona Do Not Resuscitate Order?

An Arizona Do Not Resuscitate Order (DNR) is a legal form in which a person can specify their wish not to receive cardiopulmonary resuscitation (CPR) if their heart stops or they stop breathing. This document is used to inform medical personnel and emergency responders of this preference.

Who can request an Arizona DNR?

Any competent individual over the age of 18, or a legal guardian or healthcare proxy of someone who is unable to make medical decisions for themselves, can request a DNR order in Arizona.

How do I obtain an Arizona DNR form?

The Arizona Department of Health Services provides the DNR form online. It can be downloaded from their official website. Alternatively, a healthcare provider can also provide the form upon request.

What is required for an Arizona DNR to be valid?

For a DNR to be considered valid in Arizona, it must be signed by the individual requesting it (or their legally authorized representative) and a licensed healthcare provider. This includes a physician, nurse practitioner, or physician assistant who has reviewed the individual's health status.

Does the Arizona DNR need to be notarized?

No, the Arizona DNR form does not require notarization. However, it must be signed by the authorized healthcare provider and the requester or their legal representative to be valid.

Where should I keep my Arizona DNR?

It is recommended to keep the original DNR in a location that is easily accessible to emergency personnel. Copies can be given to your healthcare provider, close family members, and might also be included in medical records or living wills.

Can I change or cancel my Arizona DNR?

Yes, an individual who has issued a DNR can change or cancel it at any time. To do so, they must communicate their wish to their healthcare provider or destroy the original DNR form and any copies. It is also advised to inform family members and healthcare providers of the change or cancellation.

What happens if emergency medical personnel are not aware of my Arizona DNR?

If emergency personnel are not aware of your DNR order, they are likely to proceed with life-saving measures, including CPR, by default. It is crucial to ensure that your DNR order is easily accessible and that close family members or roommates are aware of its existence and location.

Is an Arizona DNR valid in other states?

The validity of an Arizona DNR in other states may vary. Each state has its own laws and regulations regarding DNR orders. It's advisable to check with healthcare providers or legal professionals in any other state where you spend a significant amount of time.

Do DNR orders apply to other forms of medical treatment?

No, a DNR order specifically relates to CPR and does not apply to other forms of medical treatment. Individuals interested in specifying their wishes regarding other treatments should consider an advance directive or a living will.

Common mistakes

Completing a Do Not Resuscitate (DNR) Order form in Arizona is an important step for those who wish to document their preferences about not receiving CPR (Cardiopulmonary Resuscitation) in the event their breathing stops or their heart stops beating. However, mistakes made during this process can lead to confusion and the potential for not having one's wishes honored. Here are four common mistakes:

  1. Not using the correct form: Arizona has a specific form that must be used for a DNR order to be valid. Sometimes people mistakenly fill out forms meant for other states, or they use outdated versions of the Arizona form. It’s important to ensure you’re using the most current form specifically designed for Arizona.

  2. Leaving sections incomplete: Every section of the form is important and requires attention. Sometimes, people skip over sections or leave them blank, thinking they are not applicable. This can cause the form to be invalid. It’s crucial to review and fill out every section carefully.

  3. Incorrect witness signatures: Arizona law requires that the DNR order be witnessed by certain individuals who meet specific criteria. A common mistake is having the form witnessed by someone who does not qualify, such as a family member who stands to inherit from the person's estate. Witnesses should be chosen carefully to ensure they meet Arizona's legal requirements.

  4. Not discussing with healthcare providers: Before completing a DNR form, it’s advisable to discuss your decisions with a healthcare provider. Some people fill out the form without having a clear understanding of the medical implications. Healthcare providers can offer valuable insights into how a DNR order fits into your overall health care plan.

Making sure your DNR order is correctly completed and valid is crucial in ensuring that your wishes are respected in critical moments. Double-checking each of these areas can help avoid common pitfalls and provide peace of mind for both you and your loved ones.

Documents used along the form

When an individual decides to have a Do Not Resuscitate (DNR) order in Arizona, it's often just one part of their broader health care and end-of-life planning strategy. This decision impacts not only the individual but also their family and healthcare providers. To ensure that all aspects of one's wishes are known and respected, a DNR is usually accompanied by other legal documents. These forms work together to create a comprehensive plan that guides medical professionals and loved ones during critical moments. Here's a look at some of these important documents:

  • Living Will: A document that outlines an individual's preferences for medical treatment in situations where they cannot make decisions for themselves. It can specify wishes regarding life support, artificial hydration, and nutrition.
  • Health Care Power of Attorney: A legal document that designates another person (often a family member or close friend) as the individual's representative to make healthcare decisions on their behalf if they are unable to do so.
  • Mental Health Care Power of Attorney: Similar to a Health Care Power of Attorney, but specifically focuses on decisions related to mental health treatment.
  • Pre-Hospital Medical Directive (Orange Form): An emergency medical form, also known as the orange form due to its color, that alerts first responders and healthcare providers to the presence of a DNR order.
  • Living Trust: A legal arrangement where an individual's assets are placed within a trust to be managed by a trustee for the benefit of the person's beneficiaries, which can also include instructions for health care in the event the individual becomes incapacitated.
  • Will: A legal document that communicates an individual's wishes regarding the distribution of their property and the care of any minor children after their death.
  • Organ and Tissue Donor Card: A card or registration form that indicates an individual's wish to donate their organs and tissues after death. This can also be registered online in many states.
  • Portable Medical Orders: For those with serious health conditions, this set of physician's orders ensure that the patient’s treatment preferences are followed across different healthcare settings.
  • Financial Power of Attorney: A document that assigns a person or organization the authority to handle financial transactions on behalf of the individual, should they become unable to manage their own finances.

Each document serves a unique purpose, yet they all converge to ensure that an individual's health care preferences are observed and respected. Having these forms in place alongside a Do Not Resuscitate order provides peace of mind, clarity, and direction to all involved during challenging times. It's about taking control of your medical treatment and ensuring your wishes are known, even when you can't speak for yourself. Thoughtful planning today can make a world of difference tomorrow.

Similar forms

The Arizona Do Not Resuscitate (DNR) Order form shares similarities with the Advanced Healthcare Directive. Both documents allow individuals to express their wishes regarding medical treatment in situations where they may not be able to communicate these preferences themselves. However, while the DNR specifically addresses the desire not to undergo cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest, an Advanced Healthcare Directive covers a broader range of medical treatments and life-sustaining measures.

Living Wills also bear resemblance to the DNR Order, as they provide instructions on end-of-life care. The key difference is that a Living Will typically includes more detailed decisions about different types of life-sustaining treatments beyond CPR, such as mechanical ventilation or feeding tubes, whereas a DNR order is focused solely on not initiating CPR.

Power of Attorney (POA) for healthcare is another document with similarities to a DNR. Both empower individuals to make critical healthcare decisions in advance of incapacity. However, a healthcare POA designates another person to make healthcare decisions on behalf of the individual, including decisions not covered by a DNR, whereas a DNR directly communicates the individual's wishes regarding CPR without appointing a decision-maker.

The POLST (Physician Orders for Life-Sustaining Treatment) form is similar to the DNR in that both are medical orders that specify the types of emergency treatment a patient wishes to receive or avoid. The POLST form, though, goes beyond the scope of CPR to include other treatments such as antibiotics, intubation, and feeding tubes. Both documents aim to ensure that a patient’s preferences are respected during critical or end-of-life care.

Emergency Medical Identification Bracelets, which provide quick reference to critical medical conditions or wishes, can be considered in alignment with DNR orders. While these bracelets usually alert first responders to a variety of specific health issues (like allergies or diabetes), they can also indicate a person’s DNR status, ensuring that the individual’s choice regarding CPR is respected even if the physical DNR document is not immediately available.

Hospital Admission forms may have sections that inquire about a patient's advance directives or resuscitation wishes, making them tangentially similar to DNR orders. These forms help to ensure that a patient's preferences are acknowledged and adhered to from the point of admission, covering a variety of medical treatments and procedures, including but not limited to resuscitation efforts.

A Five Wishes document, like a DNR, addresses a person's healthcare preferences, but in a more holistic manner. This document combines elements of a living will and a healthcare power of attorney, detailing a person’s wishes concerning their personal, spiritual, and medical care at the end of life. It encourages individuals to consider their comfort, how they want to be treated, and what they want their loved ones to know, in addition to specifying medical treatments they wish to receive or avoid.

Organ Donor Cards, while primarily indicating one’s intention to donate organs and tissues after death, share the essence of pre-deciding healthcare-related choices much like DNR orders. Both serve as declarations of medical intentions that are meant to be honored in the critical moments following an individual’s death or at the end of their life, despite serving different ends.

Last Will and Testament documents, focusing on estate and property issues post-mortem, also align with DNR orders in a broader context of planning and preparing for the inevitable. Both kinds of documents require forethought and decision-making about personal matters before incapacity or death. While Last Wills distribute assets according to the deceased's wishes, DNR orders instruct healthcare professionals on the life-saving measures that should or should not be taken.

Dos and Don'ts

In Arizona, filling out the Do Not Resuscitate (DNR) Order form is a critical process for those who wish to make their end-of-life care preferences known. To ensure that your wishes are clearly documented and legally recognized, there are important guidelines to follow. Below are lists of what you should and shouldn't do when completing this form:

Things You Should Do

  1. Review the form carefully before filling it out. Understanding each section can help ensure that all necessary information is accurately provided.
  2. Consult with a healthcare provider. It's important to discuss your wishes with a healthcare provider who can clarify any medical terms and ensure that the document reflects your end-of-life care preferences.
  3. Use legible handwriting or type the information if the form allows. This is crucial to prevent any misunderstandings regarding your wishes.
  4. Include a witness or notarization if required by state law. Some states may require a witness's signature or notarization to validate the DNR order.
  5. Keep the completed form in an easily accessible location and inform family members or caregivers of its location. In an emergency, medical personnel should be able to locate the form quickly to abide by your wishes.

Things You Shouldn't Do

  • Don't fill out the form alone if you have questions or uncertainties. Seek advice from healthcare providers or a legal professional to ensure your directives are clear and lawful.
  • Don't skip details that confirm your identity, such as your full name, date of birth, and address. These details are necessary for the DNR order to be accurately connected to you.
  • Don't use ambiguous language. Your care preferences should be expressed clearly to avoid any potential confusion or misinterpretation.
  • Don't forget to update the form if your wishes change. A DNR order can be revoked or modified, but it is important to complete a new form and inform all relevant parties of the change.
  • <Don't keep your wishes a secret from your family or healthcare proxy. Discussing your decision with loved ones can help ensure your wishes are understood and respected.

Misconceptions

When discussing the Arizona Do Not Resuscitate (DNR) Order form, several misconceptions frequently arise, leading to confusion and incorrect assumptions about its use and implications. Let’s clarify some of these common misunderstandings.

  • Only the elderly can have a DNR order. People often believe that DNR orders are exclusively for older adults, but in reality, anyone, regardless of age, who wishes to avoid CPR in the event their heart or breathing stops can opt for a DNR order. It's about personal choice and medical recommendations, not age.

  • A DNR order means no emergency treatment. There's a common misconception that a DNR order restricts all forms of emergency care. However, this is not accurate. A DNR specifically addresses CPR. It does not stop medical personnel from providing other forms of necessary treatment to manage pain or other conditions.

  • The DNR order is the same as a living will. Although both documents are advance directives, they serve different purposes. A living will expresses wishes for end-of-life care on a broader scale, while a DNR order specifically directs healthcare providers not to perform CPR. The two serve to complement each other but are distinct.

  • One DNR order works everywhere. This is not true; the recognition of DNR orders can vary depending on location and setting. For example, a DNR order issued in Arizona might not be immediately recognized in a different state without additional processes or documentation. Furthermore, hospital DNR orders may not apply outside of the hospital setting, such as at home or in public places.

  • DNR orders are irreversible. Many think once a DNR order is in place, it cannot be changed. This is not the case; a DNR can be revoked or updated at any time based on the individual's wishes, medical advice, or changing conditions.

  • Only a patient can request a DNR order. While it’s true the patient's consent is ideal, in situations where the patient is unable to make their own healthcare decisions, legal guardians, healthcare proxies, or family members authorized by healthcare power of attorney can request a DNR order on behalf of the patient.

  • Having a DNR order means giving up on life. Choosing a DNR order is not about giving up. Instead, it's about making a conscious decision on how one wishes to be treated in the latter stages of life or during a critical medical situation. It reflects a preference for natural progression over invasive medical interventions in specific circumstances.

Key takeaways

If you or a loved one is considering filling out a Do Not Resuscitate (DNR) Order in Arizona, it's important to approach this decision with a clear understanding of what it means and the implications it carries. Here are four key takeaways about the Arizona Do Not Resuscitate Order form that can guide you through the process:

  • Understanding the Purpose: The DNR Order is designed to communicate a person's wish not to have cardiopulmonary resuscitation (CPR) performed in the event their heart stops or they stop breathing. This document is crucial for those who want their medical treatment to reflect their end-of-life wishes.
  • Legal Requirements: For a DNR Order to be considered valid in Arizona, it must meet certain legal criteria. It needs to be signed by the individual (or their legal representative) and their healthcare provider, indicating a mutual agreement on the decision not to pursue resuscitation in emergencies.
  • Accessibility is Key: Once completed, the DNR Order should be kept in an easily accessible place. Emergency personnel need to see the document quickly during an emergency situation to honor the wishes stated. Copies can also be registered with medical facilities where the individual receives care.
  • Revocation Process: It's important to note that an individual or their legal representative can revoke the DNR Order at any time. This revocation can be done through a verbal or written statement to the healthcare provider. Knowing how to revoke the order is as crucial as setting it up, providing flexibility and peace of mind that one's wishes can be adapted as circumstances change.

Completing a Do Not Resuscitate Order is a significant step in planning for medical care and should be done with careful consideration and understanding of the implications. It ensures that the medical treatment aligns with the personal wishes of the individual, especially in critical moments.

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