This is a state specific form specifying your desires that, should you experience cardiac or pulmonary failure in a location other than an acute care hospital or a health facility, cardiopulmonary resuscitation procedures be withheld or withdrawn and that you be permitted to die naturally.
Indianapolis Indiana Out of Hospital - Do not Resuscitate Declaration - DNR - Statutory Form
State:
Indiana
City:
Indianapolis
Control #:
IN-P022
Format:
Word;
Rich Text
Instant download
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Description
How to fill out Indiana Out Of Hospital - Do Not Resuscitate Declaration - DNR - Statutory Form?
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FAQ
What if the Family Disagrees with the DNR Order? If the family disagrees with the DNR order, then they have a right to speak with the attending physician. The physician should make a reasonable effort to explain the patient's prognosis and treatment options, along with the patient's wishes.
The DNR Customer Service Center can be reached by phone at 317-232-4200 or 877-463-6367, or by email at CSCinquiry@dnr.IN.gov, a.m. - 4 p.m. Monday through Friday.
Exemptions: Landowners or lessees of farmland who farm that land and are residents of Indiana are not required to obtain a permit while hunting, fishing, or trapping on the land they own or lease. A license is also NOT required for the landowner's or lessee's spouse or children living with them.
Never shoot or chase a deer on a property without explicit permission. Doing so is not only rude, it's illegal in Indiana.
notresuscitate order (DNR) is a legally binding physician's order stating that no steps will be taken to restart a patient's heart or restore breathing if the patient experiences cardiac arrest or respiratory arrest.
On-line Medical Control must be consulted in cases involving validation of DNR orders. A DNR order may be invalidated if the immediate cause of a respiratory or cardiac arrest is related to trauma or mechanical airway obstruction. b) Death has been declared by the patient's physician or the coroner.
Unfortunately, it is not necessary for a patient or their family to give their consent to a DNR. However, they should be involved in the decision-making process and ensure that the doctor has all of the relevant facts before making a decision.
You can write an advance directive in several ways: Use a form provided by your doctor. Write your wishes down by yourself. Call your health department or state department on aging to get a form. Call a lawyer. Use a computer software package for legal documents.
The patient's physician must approve of a DNR, confirming the patient's condition by signing the DNR form. Aside from the patient's and physician's signatures, two (2) witnesses are required to make a DNR order valid. Required to Sign ? Patient, physician and two (2) witnesses.
The attending physician/provider must provide the DNR/DNAR order, either in writing or verbally. A verbal DNR/DNAR order may be taken by a licensed nurse and co-signed by the physician/provider within 24 hours. Agreed to by the designated healthcare agent(s), for a patient without decision-making capacity.