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In Massachusetts, the Do Not Resuscitate (DNR) Order form serves as a crucial tool for individuals who wish to express their preferences regarding medical interventions in the event of a cardiac arrest or respiratory failure. This legally recognized document allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures, ensuring that their wishes are respected during critical moments. The form must be signed by a licensed physician and requires the patient's or their authorized representative's consent, making it essential for families and healthcare providers to have open discussions about end-of-life care. Additionally, the DNR Order must be readily accessible to medical personnel, as its presence can significantly influence the course of treatment in emergency situations. Understanding the implications of this form, along with the necessary procedures for its completion and implementation, is vital for anyone considering their options for advanced care planning. As healthcare decisions can be complex and emotionally charged, having clarity on the DNR process can empower individuals and their loved ones to make informed choices that align with their values and preferences.
Dos and Don'ts
When filling out the Massachusetts Do Not Resuscitate Order form, it's important to follow certain guidelines to ensure your wishes are clearly communicated. Here’s a list of things you should and shouldn't do:
- Do ensure that the form is signed by a qualified healthcare provider.
- Do discuss your wishes with family members and healthcare proxies.
- Do keep the form in an easily accessible place, such as with your medical records.
- Do review the form regularly to ensure it reflects your current wishes.
- Don't fill out the form without understanding its implications.
- Don't forget to provide copies to your healthcare providers and loved ones.
PDF Properties
| Fact Name | Description |
|---|---|
| Governing Law | The Massachusetts Do Not Resuscitate (DNR) Order is governed by Massachusetts General Laws Chapter 111, Section 70E. |
| Purpose | The DNR Order is designed to inform healthcare providers that a patient does not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. |
| Eligibility | Any adult patient who is capable of making their own medical decisions can request a DNR Order. |
| Signature Requirement | The DNR Order must be signed by the patient or their legally authorized representative. |
| Healthcare Provider's Role | A physician must sign the DNR Order to validate it, ensuring that it is based on the patient's medical condition and wishes. |
| Form Accessibility | The DNR Order form is available online and can also be obtained from healthcare facilities and providers. |
| Revocation | Patients can revoke a DNR Order at any time, and this can be done verbally or in writing. |
| Emergency Medical Services (EMS) | EMS personnel are required to honor a valid DNR Order when they encounter a patient in cardiac or respiratory arrest. |
| Storage and Display | The DNR Order should be kept in an easily accessible location, such as on the refrigerator or with the patient’s medical records. |
| Education and Awareness | Patients and families are encouraged to discuss the implications of a DNR Order with healthcare providers to ensure informed decisions. |
Key takeaways
Filling out and using the Massachusetts Do Not Resuscitate (DNR) Order form is an important step in ensuring that your healthcare wishes are respected. Here are some key takeaways to keep in mind:
- Understand the Purpose: A DNR order is a medical directive that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing.
- Eligibility: Any adult can complete a DNR order, but it is especially relevant for individuals with serious illnesses or those who wish to avoid aggressive medical interventions.
- Consult with Healthcare Providers: Before filling out the form, discuss your wishes with your doctor. They can provide guidance on the implications of a DNR order.
- Complete the Form Accurately: Ensure that all required fields are filled out correctly, including your name, date of birth, and signature, as well as the signature of a witness.
- Notify Your Healthcare Team: Once the DNR order is completed, share copies with your healthcare providers, family members, and anyone involved in your care.
- Review Regularly: Your health status and preferences may change over time. Regularly review and update your DNR order as necessary.
- Keep It Accessible: Store the DNR order in a place where it can be easily found by medical personnel, such as on your refrigerator or in your medical records.
By understanding these key points, you can ensure that your wishes regarding resuscitation are clearly communicated and respected in a medical emergency.
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Example - Massachusetts Do Not Resuscitate Order Form
Massachusetts Do Not Resuscitate Order Template
This Do Not Resuscitate (DNR) Order is designed for use in the state of Massachusetts. It is a legally recognized document that informs medical professionals of a person's wishes regarding resuscitation efforts in case of cardiac arrest or respiratory failure.
By completing this form, I, [Patient's Name], born on [Date of Birth], understand that I am making an important decision about my medical care.
My current address is:
[Address]
Please indicate my preferences regarding resuscitation:
- ❏ I do not wish to receive cardiopulmonary resuscitation (CPR) if my heart stops or if I stop breathing.
- ❏ I consent to do not resuscitate order in accordance with Massachusetts state laws.
This order is effective until revoked or altered by me, or my legally appointed representative. I understand that I can change my mind at any time about this order. To revoke this order, I must inform my healthcare provider and complete a new DNR order.
By signing below, I affirm that I have completed this document voluntarily and understand its content:
Patient's Signature: ________________________ Date: ________________
If applicable, the following individual is my authorized healthcare proxy:
Proxy Name: [Proxy's Name]
Proxy Address: [Proxy's Address]
Proxy Phone Number: [Proxy's Phone Number]
Proxy Signature: ________________________ Date: ________________
This Do Not Resuscitate Order must be signed by my physician:
Physician's Name: [Physician's Name]
Physician's Contact Information: [Physician's Contact Information]
Physician's Signature: ________________________ Date: ________________
This form should be kept in a place where it can be readily found in case of a medical emergency.
Detailed Instructions for Writing Massachusetts Do Not Resuscitate Order
Completing the Massachusetts Do Not Resuscitate Order form is an important step in expressing your healthcare wishes. By following the steps outlined below, you can ensure that your preferences are clearly documented and respected. Make sure to gather any necessary information before you begin filling out the form.
- Obtain the Massachusetts Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
- Begin by entering your full name at the top of the form. This helps to clearly identify your wishes.
- Provide your date of birth. This information is crucial for confirming your identity.
- Fill in your address. Include the street address, city, state, and zip code.
- Next, indicate the name of your healthcare proxy, if you have one. This person will be responsible for making decisions on your behalf if you are unable to do so.
- Sign and date the form. Your signature confirms that you understand and agree to the contents of the document.
- Have your healthcare proxy and a witness sign the form as well. This adds an extra layer of validation to your wishes.
- Make copies of the completed form. Distribute them to your healthcare provider, your healthcare proxy, and keep a copy for your records.
After you have filled out the form, it’s essential to communicate your wishes with family members and healthcare providers. This ensures that everyone is aware of your preferences and can act accordingly when necessary.
Documents used along the form
In Massachusetts, the Do Not Resuscitate (DNR) Order form is an important document for individuals who wish to express their preferences regarding resuscitation efforts in the event of cardiac arrest. However, several other forms and documents are often used in conjunction with a DNR to ensure that a person's healthcare wishes are clearly communicated and respected. Below is a list of these documents, along with brief descriptions of each.
- Healthcare Proxy: This document allows an individual to appoint someone else to make medical decisions on their behalf if they become unable to do so. It is crucial for ensuring that a person's healthcare preferences are honored.
- Living Will: A living will outlines a person's wishes regarding medical treatment in situations where they are unable to communicate their preferences. It typically addresses end-of-life care and the use of life-sustaining treatments.
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- Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that specifies the types of medical treatment a patient wishes to receive during a medical emergency. It is designed for individuals with serious health conditions and complements the DNR order.
- Advance Directive: This broader term encompasses both healthcare proxies and living wills. It serves as a written statement detailing a person's healthcare preferences and appointing someone to make decisions if they cannot speak for themselves.
- Patient Information Form: This form collects essential information about the patient’s medical history, current medications, and emergency contacts. It helps healthcare providers understand the patient's needs and preferences quickly.
- Emergency Medical Services (EMS) Protocols: These are guidelines that EMS personnel follow during emergencies. They may reference a DNR order or POLST to determine the appropriate course of action in line with the patient's wishes.
- Medical Record Release Form: This document allows individuals to authorize the sharing of their medical records with designated individuals or organizations. It ensures that healthcare providers have access to relevant information when making decisions.
- Do Not Hospitalize (DNH) Order: Similar to a DNR, a DNH order indicates that a patient does not wish to be admitted to a hospital for treatment. This can be particularly relevant for patients nearing the end of life.
Using these documents in conjunction with the Massachusetts DNR Order form can provide clarity and support for individuals and their families. It is important to ensure that all forms are completed accurately and stored in an accessible location to facilitate effective communication of healthcare wishes during critical moments.