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In the realm of healthcare, individuals often face difficult decisions regarding end-of-life care. One critical tool available in Tennessee is the Do Not Resuscitate (DNR) Order form. This document allows a person to express their wishes about resuscitation efforts in the event of a medical emergency. It is designed to ensure that medical professionals respect a patient's desire to forgo life-saving measures, such as CPR or advanced cardiac life support. Completing this form involves specific criteria, including the necessity for a physician's signature, which confirms that the individual understands the implications of the decision. Additionally, the DNR Order must be clearly communicated to healthcare providers and family members to avoid confusion during critical moments. By understanding the DNR Order form, individuals can make informed choices about their healthcare preferences, ensuring their wishes are honored when they can no longer speak for themselves.

Similar forms

The Tennessee Do Not Resuscitate Order (DNR) form is similar to an Advance Directive, which is a broader legal document that outlines a person’s wishes regarding medical treatment in the event they become unable to communicate. An Advance Directive can include specific instructions about resuscitation, as well as other medical interventions. This document empowers individuals to express their healthcare preferences, ensuring that their wishes are respected even when they cannot voice them. Like the DNR, it serves to guide healthcare providers and family members in making decisions that align with the individual's values and desires.

Another document akin to the DNR is a Living Will. A Living Will specifically details the types of medical treatment a person wishes or does not wish to receive if they are terminally ill or in a persistent vegetative state. While a DNR focuses on resuscitation efforts, a Living Will encompasses a wider range of medical scenarios, providing clarity on life-sustaining treatments such as artificial nutrition and hydration. Both documents aim to relieve family members from the burden of making difficult decisions during emotionally charged times, ensuring that the patient’s preferences are honored.

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The Medical Power of Attorney (POA) is also similar to the DNR in that it designates an individual to make healthcare decisions on behalf of another person. This document becomes crucial when a person is incapacitated and unable to express their wishes. While a DNR specifically addresses resuscitation, a Medical POA can cover a broader spectrum of medical decisions, allowing the appointed agent to act according to the patient’s values and preferences. This relationship between the DNR and Medical POA highlights the importance of having clear communication about healthcare wishes.

The Physician Orders for Life-Sustaining Treatment (POLST) form shares similarities with the DNR by providing specific medical orders regarding resuscitation and other life-sustaining treatments. POLST is designed for individuals with serious health conditions and aims to ensure that their treatment preferences are documented and honored by healthcare providers. Unlike a DNR, which is primarily a request not to perform CPR, POLST can include directives for other interventions, making it a more comprehensive tool for managing end-of-life care.

A Healthcare Proxy is another document that resembles the DNR. This legal document allows an individual to appoint someone to make healthcare decisions on their behalf if they become incapacitated. While the DNR provides specific instructions about resuscitation, the Healthcare Proxy focuses on the appointment of a trusted person to make decisions based on the patient's wishes. This relationship emphasizes the importance of having someone who understands the patient’s values and can advocate for their preferences in various medical situations.

Lastly, the Do Not Intubate (DNI) order is closely related to the DNR, as both documents deal with end-of-life care decisions. A DNI specifically instructs healthcare providers not to place a patient on a ventilator or provide artificial ventilation, while a DNR focuses on the absence of resuscitation efforts. Both documents reflect a patient’s wishes regarding life-sustaining interventions and are often used together to create a comprehensive plan for end-of-life care, ensuring that the individual’s preferences are respected in critical situations.

Document Overview

Fact Name Description
Definition A Do Not Resuscitate (DNR) Order is a legal document that informs medical personnel not to perform CPR if a person's heart stops beating.
Governing Law The Tennessee Do Not Resuscitate Order is governed by Tennessee Code Annotated § 68-11-203.
Eligibility Any adult can request a DNR order, provided they are of sound mind and understand the implications.
Signature Requirement The form must be signed by the patient or their legal representative and a physician.
Form Availability The DNR order form is available through healthcare providers, hospitals, and online resources.
Revocation A DNR order can be revoked at any time by the patient or their legal representative.
Recognition Healthcare providers in Tennessee are required to honor valid DNR orders from other states, as long as they meet specific criteria.
Emergency Services Emergency medical services must have a copy of the DNR order on file to comply with the patient's wishes.

Sample - Tennessee Do Not Resuscitate Order Form

Tennessee Do Not Resuscitate Order

This Do Not Resuscitate (DNR) order is made pursuant to the Tennessee Health Care Decision Act, Tennessee Code Annotated § 68-11-201 et seq.

Patient Information:

  • Full Name: _______________________________________
  • Date of Birth: ____/____/______
  • Address: _______________________________________
  • Phone Number: ________________________________

Health Care Provider Information:

  • Provider Name: ___________________________________
  • Contact Number: ________________________________

Declaration:

I, the undersigned, declare that I do not wish to receive resuscitation, including but not limited to cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS), in the event of a cardiac or respiratory arrest.

This order reflects my wishes regarding my medical treatment in circumstances where it is determined that I am in a state of terminal illness or otherwise unable to communicate my desires.

Signature of Patient or Authorized Representative:_______________________________________

Date: ____/____/______

Witness Information:

  • Witness Name: ___________________________________
  • Witness Signature: _____________________________
  • Date: ____/____/______

This DNR order is valid until revoked in writing. It must be honored by all health care providers across Tennessee.