Free Do Not Resuscitate Order Form for the State of Minnesota

Free Do Not Resuscitate Order Form for the State of Minnesota

The Minnesota Do Not Resuscitate Order form is a legal document that indicates a person's wish not to receive cardiopulmonary resuscitation (CPR) in the event their heart stops or they stop breathing. This critical form serves as direct communication between patients, their families, and healthcare providers to ensure that the patient's end-of-life wishes are respected. For those in Minnesota looking to make their healthcare choices known, filling out this form is an essential step. Click the button below to begin the process.

Make This Do Not Resuscitate Order Now

In the landscape of healthcare and end-of-life care decisions, the Minnesota Do Not Resuscitate Order (DNR) form occupies a crucial role. This form, a pivotal document for individuals seeking control over their medical treatment, signifies a patient's wish not to receive cardiopulmonary resuscitation (CPR) in the event that their heart stops or they stop breathing. Designed with the intent to honor the patient's autonomy and preferences at the end of their life, the DNR form is instrumental in guiding healthcare providers during critical moments, ensuring that treatment aligns with the patient's wishes. It is the product of thoughtful consideration and discussions between patients, their families, and healthcare professionals, aiming to provide clarity and peace of mind. Through the DNR form, Minnesota underscores the significance of respecting individual preferences in healthcare, reflecting a broader commitment to patient-centered care.

Minnesota Do Not Resuscitate Order Example

Minnesota Do Not Resuscitate Order Template

This document serves as a Do Not Resuscitate (DNR) Order, in accordance with the relevant provisions of Minnesota law. It is designed to inform medical personnel of the patient's wishes not to undergo cardiopulmonary resuscitation (CPR) in the event that their breathing or heartbeat stops.

Patient Information:

  • Full Name: ___________________________
  • Date of Birth: ________________________
  • Address: ______________________________
  • City: ______________________ State: MN Zip Code: __________

Statement of Directive:

I, ________________________ (patient's name), understanding the full nature and purpose of this document, hereby direct that no resuscitative measures, including CPR, be initiated or continued if my breathing or heart stops due to my medical condition. This directive is based on my right to refuse medical treatment under the laws of the State of Minnesota.

Physician Information:

  • Physician's Name: ____________________________
  • License Number: _____________________________
  • Address: _____________________________________
  • Phone Number: _______________________________

Signature Section:

This Do Not Resuscitate Order reflects my wishes. I understand that this decision will not be used to hasten my death, but to allow for a natural death in the event my condition leads to a cessation of my heartbeat or breathing.

  1. Patient's Signature: _____________________ Date: ___________
  2. Physician's Signature: ___________________ Date: ___________ (verifying patient's decision)
  3. Witness's Signature: _____________________ Date: ___________ (optional)

Instructions for Healthcare Providers:

Under Minnesota law, this Do Not Resuscitate Order is legally binding. Healthcare providers are required to follow the directives stated herein, provided the document is completed and signed in accordance with state requirements. In case of the patient's incapacity, the patient's legal guardian, healthcare agent, or next of kin may present this document to the attending healthcare provider.

This document does not preclude the patient from receiving other forms of medical care aimed at providing comfort or alleviating pain. It solely directs the withholding of CPR in circumstances where the patient has stopped breathing or their heart has stopped beating.

PDF Form Details

Fact Description
Definition A Do Not Resuscitate (DNR) Order in Minnesota is a legal instruction telling healthcare providers not to perform CPR if a patient's breathing stops or if the patient’s heart stops beating.
Governing Law Minnesota Statutes, Section 145C, known as the Health Care Directives Act, govern the creation and implementation of DNR orders in the state.
Who Can Execute The DNR order can be executed by an adult patient themselves, a healthcare agent specified in a legally valid healthcare directive, or a legal guardian if the patient is incapacitated.
Form Requirement To be valid, the DNR must be documented on a form approved by the Minnesota Department of Health, or be a part of a comprehensive healthcare directive that complies with state law.
Impact on Healthcare A DNR order instructs healthcare providers to forgo resuscitation efforts in the event of cardiac or respiratory arrest but does not affect other forms of medical treatment the patient may receive.

Guide to Using Minnesota Do Not Resuscitate Order

When it comes time to fill out a Do Not Resuscitate (DNR) Order form in Minnesota, it's crucial to understand the procedure and ensure all necessary information is accurately provided. This document is a key part of an individual's end-of-life planning, expressing their wish not to have resuscitation attempts in the event their heart stops or they stop breathing. Because of its importance, it's critical that the form is completed correctly and aligns with the wishes of the person it concerns. Here are the steps you should follow to complete the Minnesota DNR Order form properly.

  1. Start by gathering all necessary information, including the full legal name of the person the DNR Order is for, their date of birth, and their address.
  2. Review the form's requirements for healthcare provider information. You will need the name, address, and contact information of the healthcare provider or facility responsible for the patient's care.
  3. Enter the patient’s information carefully on the form, ensuring no mistakes. Accuracy is key, as this information will identify whom the DNR Order applies to.
  4. Read the directives on the form carefully. It will outline the specifics of what "Do Not Resuscitate" means in the context of Minnesota law and what actions can or cannot be taken.
  5. Both the patient (or their legal guardian/healthcare proxy) and the healthcare provider must sign the form. Ensure that these signatures are obtained and clearly written to validate the document.
  6. After completing and signing the form, make multiple copies. Keep one with the patient, give one to their healthcare provider, and consider having another in a safe but accessible location at home.
  7. Inform close family members or caregivers about the existence and the location of the DNR Order so they can assist in ensuring the patient's wishes are respected in an emergency.

Completing a DNR Order is an act of preparation and caution, reflecting deep personal decisions about end-of-life care. It is essential to approach this process with the seriousness it deserves, ensuring that the wishes of the person it concerns are clearly and legally expressed. By following these steps, you can help secure peace of mind for all involved, knowing that these important preferences are documented and accessible when needed.

Crucial Questions on This Form

  1. What is a Do Not Resuscitate (DNR) Order in Minnesota?

    A DNR Order in Minnesota is a medical document that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event a person’s breathing stops or if the heart stops beating. It’s designed for individuals who, due to a serious illness or frailty, would not benefit from the attempts of CPR and prefer to allow a natural death.

  2. How can someone obtain a DNR Order in Minnesota?

    To obtain a DNR Order in Minnesota, an individual must discuss their health care wishes with a licensed healthcare provider. This discussion typically involves reviewing the person's current health status, their values regarding life-sustaining treatments, and the likely outcomes of CPR. If a DNR Order aligns with their wishes and situation, the healthcare provider will prepare the document, which must then be signed by both the provider and the patient or the patient’s legally authorized representative.

  3. Who can consent to a DNR Order?

    Consent to a DNR Order can be given by the patient themselves if they are of sound mind and able to make their own medical decisions. If the patient is a minor or not capable of making informed decisions due to a health condition, a legally authorized representative, such as a healthcare proxy, guardian, or power of attorney holder, may consent on the patient’s behalf.

  4. Where should a DNR Order be kept?

    In Minnesota, a DNR Order should be placed in a location where it is readily accessible to emergency personnel and healthcare providers. Common places include on the refrigerator, in a personal wallet, or within the individual’s medical record if they reside in a healthcare facility. It’s critical that family members, caregivers, and healthcare providers are informed about the existence and location of the DNR Order.

  5. Is a DNR Order permanent?

    No, a DNR Order is not permanent. The individual or their legally authorized representative has the right to revoke or cancel the order at any time. This decision should be communicated to the healthcare provider as soon as possible to update the medical records. Additionally, it may be wise to destroy any physical copies of the DNR Order to prevent confusion during medical emergencies.

  6. Does having a DNR Order affect the quality of care one receives?

    A DNR Order specifically addresses the use of CPR in emergency situations where the heart stops beating or breathing ceases. It does not impact the quality or extent of other medical treatments and care the individual receives. Healthcare providers will continue to offer all other appropriate medical interventions and comfort care measures unless otherwise specified in an advance directive or similar document.

  7. Can a DNR Order be included in an advance healthcare directive?

    Yes, in Minnesota, individuals may include DNR instructions within an advance healthcare directive. An advance healthcare directive is a broader document that outlines a person’s preferences regarding various forms of medical intervention, not just CPR. Including DNR instructions in an advance directive helps ensure that a person’s wishes regarding CPR are considered alongside other treatment preferences.

Common mistakes

In Minnesota, the Do Not Resuscitate (DNR) Order form is a crucial document for individuals who prefer not to receive CPR (cardiopulmonary resuscitation) in the event their heart stops or they stop breathing. However, the process of filling out this form can be complex, and mistakes can occur. Here are five common errors to avoid:

  1. Not Consulting with a Healthcare Provider: Before filling out a DNR Order in Minnesota, it is essential to discuss your health and wishes with a healthcare provider. This form must be authorized by a physician to be valid. Skipping this step could result in a non-binding DNR Order, which healthcare professionals may not follow in an emergency.

  2. Incomplete Information: Another common mistake is leaving sections of the form blank. Every field in the DNR Order is important and provides crucial information. Incomplete forms may not be recognized, or worse, they could lead to confusion in critical moments. Pay special attention to filling out personal information, the healthcare provider's information, and the signature areas accurately.

  3. Lack of Witness or Notary Signatures: The Minnesota DNR Order form requires a witness or a notary public to validate the signing process. This step is crucial for the form's validity but is often overlooked. Ensure you have a non-family witness or a notary present to sign the document, as stipulated by the state's requirements.

  4. Forgetting to Share the DNR Order: After completing the form, it's vital to inform family members and healthcare providers about the DNR Order and where it is stored. If the form is tucked away in a safe or a drawer and not easily accessible during an emergency, it may not be found in time to honor the individual's wishes.

  5. Misunderstanding the Scope of the Form: Some people mistakenly believe that a DNR Order means "do not treat" for any and all medical conditions, but this is not the case. It specifically refers to not initiating CPR if breathing stops or if the heart stops beating. It's essential to understand that other treatments, such as pain relief or antibiotics, are not precluded by a DNR Order unless otherwise specified in additional healthcare directives.

Avoiding these mistakes can help ensure that your healthcare wishes are honored accurately and without delay. Remember, it's also important to review and update your DNR Order periodically, especially if your health status or preferences change.

Documents used along the form

When handling a Minnesota Do Not Resuscitate (DNR) Order form, it's important to consider other legal documents that can complement and clarify your healthcare and end-of-life wishes. These documents can help ensure your healthcare preferences are followed, provide guidance for your loved ones, and legally define your wishes regarding property and financial matters. Below are summaries of eight common documents often used alongside the Minnesota DNR Order form.

  • Healthcare Directive: This legal document allows you to outline your preferences for medical treatments and end-of-life care. It can also designate a healthcare agent to make decisions on your behalf if you're unable to do so.
  • Power of Attorney: A Power of Attorney permits another person to make decisions regarding your finances, property, and other non-medical matters should you become incapacitated.
  • Living Will: Similar to a Healthcare Directive, a Living Will enables you to detail your wishes for medical treatment, particularly in situations involving life-sustaining procedures.
  • Will: This document outlines how you wish your property and possessions to be distributed after your death. It also allows you to appoint an executor to carry out your directives.
  • Trust: A Trust can help manage your property and assets both during your life and after your death, often offering benefits like avoiding probate.
  • HIPAA Release Form: The Health Insurance Portability and Accountability Act (HIPAA) Release Form gives healthcare providers permission to share your health information with designated individuals.
  • Organ and Tissue Donation Registration: This form allows you to register as an organ and tissue donor, specifying your wishes regarding donation after death.
  • Guardianship Designation: This document designates someone to make decisions regarding your care and/or your estate, especially beneficial if you have dependents or are considering potential future incapacity.

In conclusion, preparing for the future involves more than just a Minnesota DNR Order form. By considering a comprehensive array of legal documents, individuals can ensure their health care preferences are known and their affairs are in order. Whether it's through a Healthcare Directive, Power of Attorney, or other forms, clearly outlining your wishes can provide peace of mind for you and your loved ones.

Similar forms

The Minnesota Do Not Resuscitate (DNR) Order bears a resemblance to the Advance Healthcare Directive. Both documents serve as critical tools for individuals planning ahead for their healthcare needs. The Advance Healthcare Directive allows individuals to outline their wishes for medical treatment, including end-of-life care, which may include directives not to undergo certain life-sustaining treatments. Similar to the DNR Order, this ensures that healthcare providers are aware of the patient's preferences in situations where the patient cannot communicate them directly.

Another document comparable to the DNR Order is the Medical Power of Attorney (POA). This legal instrument permits one to appoint a healthcare agent to make medical decisions on their behalf if they are incapacitated. While the Medical POA encompasses a broader range of medical decision-making authority, the DNR Order specifically addresses the wish not to have resuscitation attempts in the event of cardiac or respiratory arrest. Both play crucial roles in medical planning, ensuring individuals' healthcare wishes are heard and respected.

The Physician Orders for Life-Sustaining Treatment (POLST) form also shares similarities with the DNR Order. The POLST form is designed for individuals with serious health conditions and specifies the types of medical treatment they want to receive towards the end of life. Like the DNR, the POLST provides medical orders about specific treatments, including resuscitation, based on the patient’s current health status and goals. The POLST is more comprehensive but includes the DNR orders as a critical component.

Finally, the Living Will is akin to the Minnesota DNR Order in that it communicates one's wishes regarding end-of-life care. A Living Will typically outlines the types of life-prolonging medical treatments an individual wishes to decline in the event they become unable to communicate these decisions themselves. Although it covers a broader spectrum of medical interventions than the DNR Order, which is strictly about resuscitation, both documents ensure that healthcare teams are informed of a patient’s wishes regarding life-sustaining treatments.

Dos and Don'ts

In Minnesota, a Do Not Resuscitate (DNR) Order is a crucial document for those who choose not to receive CPR (cardiopulmonary resuscitation) in the event that their breathing or heartbeat stops. When filling out a DNR Order, accuracy and clarity are paramount. Below are six key things to keep in mind - three do's and three don'ts - that will help ensure the form is filled out correctly and effectively communicates your wishes.

Do:
  • Consult with a healthcare provider: Before making any decisions, it's important to discuss your health status and treatment options with a healthcare professional. This ensures that you are fully informed about what a DNR Order entails and its implications for your healthcare.

  • Use precise and clear language: To avoid any confusion, especially in emergency situations, make sure all information is accurately and clearly stated on the form. Ambiguities can lead to unintended consequences and hinder healthcare providers from adhering to your wishes.

  • Keep the form accessible: Once the DNR Order is completed and signed, it should be kept in a place where it can be easily found by family members or emergency personnel. Consider informing close family, friends, or caregivers of its location.

Don't:
  • Leave spaces blank: Any unfilled sections or unanswered questions might lead to misinterpretation of your intentions. Ensure every applicable part of the form is completed to provide clear guidance to healthcare professionals.

  • Sign without witnesses or required legal attestation: Most DNR Orders require witnessing or notarization to be considered legally valid. Skipping this step can render the document non-binding, which could lead to CPR being performed against your wishes.

  • Forget to review and update regularly: Your health condition and preferences may change over time. Regularly reviewing and, if necessary, updating your DNR Order can help ensure that it always reflects your current wishes.

Misconceptions

When it comes to end-of-life care, understanding the intricacies of legal forms like the Minnesota Do Not Resuscitate (DNR) Order is crucial. Misconceptions can lead to decisions that don't align with a person's wishes. Here, we clarify some common misunderstandings about the Minnesota DNR Order form.

  • Misconception 1: A DNR is the same as giving up on treatment.
    The purpose of a DNR is to prevent emergency medical personnel from performing CPR, not to halt all medical treatments. Individuals can still receive medications, surgeries, and other forms of care to treat illnesses and improve their quality of life.
  • Misconception 2: Only the elderly need a DNR order.
    A DNR order might be appropriate for people of any age who do not want resuscitative efforts attempted in the event their heart stops or they stop breathing, regardless of their age.
  • Misconception 3: A verbal directive is enough to enforce a DNR.
    In Minnesota, a DNR order must be documented in writing and signed by a healthcare provider to be legally valid. Verbal wishes alone are not sufficient to prevent resuscitation efforts.
  • Misconception 4: The DNR order is effective in any situation.
    A DNR order is specifically for preventing CPR in the event of cardiac or respiratory arrest. It does not apply to other medical interventions.
  • Misconception 5: DNR orders cannot be revoked.
    Individuals or their legal representatives have the right to revoke a DNR order at any time. This revocation should also be communicated clearly to the healthcare team.
  • Misconception 6: DNR orders are only for hospital settings.
    While often associated with hospital settings, DNR orders are also valid in non-hospital settings, such as at home or in hospice care. However, it is important to ensure that the DNR order is accessible and known to those who might need to enact it.
  • Misconception 7: Having a DNR means you cannot have a health care proxy.
    A DNR order and a healthcare proxy (or healthcare power of attorney) serve different purposes. You can, and often should, have both. A healthcare proxy can make a wide range of healthcare decisions on your behalf if you're unable to do so, while a DNR strictly limits the actions responders can take in a resuscitation scenario.
  • Misconception 8: If you live in a different state, your Minnesota DNR won't be recognized.
    Although recognition can vary, many states have processes to recognize out-of-state DNR orders. It's important to familiarize yourself with the regulations of any state in which you spend significant time.

Understanding these nuances ensures that individuals can make informed decisions about their end-of-life care preferences. As always, consulting with healthcare professionals and legal advisors can provide clarity specific to personal circumstances and ensure that documentation accurately reflects an individual's wishes.

Key takeaways

Filing out and using the Minnesota Do Not Resuscitate (DNR) form is a critical part of end-of-life planning for those who wish to forego resuscitative efforts in the event of a cardiac or respiratory arrest. Understanding the key takeaways can ensure that individuals are fully informed and their wishes are respected. Here are ten important aspects to consider:

  • The person's clear desire not to have resuscitation attempts made in the event of a cardiac or respiratory arrest is essential for a DNR order to be established.
  • A healthcare provider's signature is mandatory for the DNR order to be valid and actionable by healthcare professionals.
  • It is crucial to discuss one's wishes regarding resuscitation with family members and healthcare providers to avoid any confusion or misunderstanding.
  • The DNR order should be easily accessible to healthcare professionals, preferably kept in a visible and well-known location within the person’s residence.
  • For the DNR order to be effective, it must comply with Minnesota state laws and regulations governing such documents.
  • Individuals have the right to revoke their DNR order at any time, should they change their minds regarding their end-of-life care wishes.
  • Communication with emergency medical services (EMS) is important to ensure that the DNR order is respected in the event of an emergency.
  • Having a durable power of attorney for healthcare or a healthcare proxy who is aware of the individual's wishes can provide an additional safeguard for ensuring those wishes are followed.
  • It is advisable to review and possibly update the DNR order periodically, especially after any significant changes in health status or personal wishes.
  • The Minnesota DNR order is specific to resuscitation efforts and does not address other forms of medical treatment or end-of-life care preferences.

It is of utmost importance for individuals to understand the implications of a DNR order fully. Making informed choices about end-of-life care wishes can bring peace of mind to the individual and their loved ones. Legal advice or consultation with healthcare providers can help in making these critical decisions and ensuring that the documentation accurately reflects the individual's desires.

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