Attorney-Approved  Do Not Resuscitate Order Form for Michigan Prepare Form Here

Attorney-Approved Do Not Resuscitate Order Form for Michigan

A Michigan Do Not Resuscitate Order form is a legally binding document that instructs healthcare professionals not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient’s heart stops beating. It is designed for individuals who wish to avoid certain life-prolonging treatments. This form must be completed and signed by both the patient and their physician to be valid.

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In the landscape of end-of-life care, individuals in Michigan have the ability to exercise control over the medical interventions they receive through the Michigan Do Not Resuscitate Order form. This critical document serves as a directive to healthcare providers, indicating a patient's wish not to undergo cardiopulmonary resuscitation (CPR) in the event their heart stops or they stop breathing. Created to respect the patient's autonomy and preferences, this form is a legally binding order acknowledged by medical personnel across various care settings, from hospitals to nursing homes. Its implementation requires careful consideration, documentation, and conversation with healthcare professionals and loved ones. Understanding its purpose, the process of its execution, and its implications is essential for any Michigan resident considering this path. The form acts not only as a vehicle for expressing patient wishes but also as a tool for families and healthcare providers to ensure that those wishes are honored, emphasizing the importance of informed consent and personal choice in medical care.

Michigan Do Not Resuscitate Order Sample

This Michigan Do Not Resuscitate Order template is designed to be completed by residents of Michigan who wish to formally refuse certain life-sustaining treatments, in compliance with the Michigan Do-Not-Resuscitate Procedure Act (Public Act 193 of 1996). Please ensure the information provided is accurate and consult with a healthcare professional or legal advisor if necessary.

Personal Information

Full Name: ___________________________________________________

Date of Birth: ______________________

Address: _____________________________________________________

City: ___________________________ State: MI Zip Code: ___________

Do Not Resuscitate Declaration

I, _____________________________, being of sound mind and fully capable of making my own health care decisions, hereby affirm my desire to forego resuscitation attempts by emergency medical services personnel, hospital staff, or other health care providers. This decision is made in accordance with the Michigan Do-Not-Resuscitate Procedure Act. I understand this order does not affect the provision of other emergency care, including comfort care, provided to me.

Physician Information

Physician's Name: _____________________________________________

Address: _____________________________________________________

City: ___________________________ State: MI Zip Code: ___________

Phone Number: ___________________ License Number: ______________

Signature

This document is legally binding. Confirmation by the individual (or their legally authorized representative) and the attending physician is required.

Signature of Declarant (or Legally Authorized Representative): ___________________________________ Date: ____________

Print Name of Declarant (or Representative): ____________________________________________________

Signature of Witness (18 years or older): _______________________________________________________ Date: ____________

Print Name of Witness: ______________________________________________________________________

Signature of Attending Physician: _____________________________________________________________ Date: ____________

Print Name of Attending Physician: ____________________________________________________________

This order must be reviewed periodically and is recommended to be visibly placed within the residence and/or carried by the individual.

Revocation of Do Not Resuscitate Order

This Do Not Resuscitate Order remains in effect until it is revoked. A revocation can be done by the declarant or their legally authorized representative at any time and in any manner that communicates an intent to revoke.

For further information and guidance, it is recommended that residents review the full text of the Michigan Do-Not-Resuscitate Procedure Act and consult with legal or healthcare professionals.

PDF Specifications

Fact Number Description
1 Michigan's Do Not Resuscitate (DNR) Order form is governed by the Michigan Do-Not-Resuscitate Procedure Act of 1996.
2 The form is intended for individuals who wish to refuse any form of resuscitation attempts in the event they suffer cardiac or respiratory arrest.
3 A valid DNR order must be signed by both the patient (or their legally authorized representative) and a licensed physician, physician assistant, or nurse practitioner.
4 The form, once completed and properly signed, allows emergency personnel to honor the individual's wishes regarding resuscitation in settings outside of a hospital.
5 The act specifies that the DNR order does not affect the provision of other types of emergency or medical care not related to resuscitation.
6 Minors can have a DNR order established on their behalf by a parent or guardian, in consultation with the minor's physician.
7 To revoke the DNR order, a patient or their authorized representative can either inform the attending physician verbally or by destroying the DNR order form.

Detailed Steps for Using Michigan Do Not Resuscitate Order

Completing a Do Not Resuscitate (DNR) order in Michigan is a significant step for individuals who wish to make clear their preferences for medical care in situations where they cannot speak for themselves. This legal document tells healthcare providers not to perform CPR if your breathing stops or if your heart stops beating. Filling out this form correctly ensures your wishes are known and can be followed by first responders and medical professionals. Here are the steps to fill out the Michigan DNR order form:

  1. Locate the most current version of the Michigan Do Not Resuscitate Order form. This can usually be found on the Michigan Department of Health and Human Services website or through your healthcare provider.
  2. Read the form thoroughly to understand the implications and requirements. Knowledge about what you're signing is crucial for making an informed decision.
  3. Enter your full legal name in the space provided. Ensure the spelling matches your identification and medical records.
  4. Provide your date of birth, making sure it is accurate and formatted correctly, usually as Month/Day/Year.
  5. Fill in your complete address, including the city, state, and zip code, to ensure you can be easily identified and that your DNR order can be properly registered or found in the system.
  6. Specify your gender by checking the appropriate box. This information is used to correctly identify you in medical records.
  7. Review the witness section and ensure you understand who qualifies to be a witness for your DNR order. Michigan law requires witnesses to meet certain criteria, so make sure the people you choose comply with these.
  8. Sign and date the form in the presence of your chosen witnesses. Your signature is a confirmation of your understanding and agreement with the DNR order.
  9. Have your witnesses sign and date the form as well. Their signatures validate the authenticity of the process and confirm your decision was made freely and without coercion.
  10. If applicable, have your physician sign the form. Some versions of the form require a physician's signature to confirm your medical condition and your capacity to make healthcare decisions.
  11. Keep the original copy of your completed DNR order in a safe but accessible place. Inform close family members, caregivers, or friends about its location, and consider giving copies to your healthcare providers for your medical records.

Once you have completed these steps, your Michigan Do Not Resuscitate Order will be active. Remember, you can update or revoke your DNR order at any time should your wishes or circumstances change. It's advisable to review it periodically and especially after any major health diagnoses or life events.

Things to Know About Michigan Do Not Resuscitate Order

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

    A Do Not Resuscitate (DNR) Order in Michigan is a legal form that tells healthcare providers not to perform CPR (cardiopulmonary resuscitation) if a person's breathing stops or if their heart stops beating. It's used by individuals who wish to avoid aggressive life-saving measures at the end of life.

  2. Who can have a DNR Order in Michigan?

    Adults who are mentally capable of making their own health care decisions can request a DNR Order. This also applies to emancipated minors and parents or guardians acting on behalf of a minor or an adult who is unable to make these decisions for themselves.

  3. How do I get a DNR Order in Michigan?

    To obtain a DNR Order, you'll need to discuss your wishes with your healthcare provider. They can help you fill out the form accurately. Once complete, the form must be signed by you (or your legal representative) and your healthcare provider.

  4. Is a DNR Order permanent?

    No, a DNR Order is not permanent. You have the right to change your mind at any time. To cancel a DNR Order, it's enough to inform your healthcare provider of your decision verbally or in writing.

  5. What happens if I don't have a DNR Order in Michigan?

    If you do not have a DNR Order, medical personnel are typically required to attempt resuscitation if you stop breathing or if your heart stops beating. This could include CPR or advanced lifesaving measures.

  6. Does a Michigan DNR Order work in other states?

    Not always. DNR Orders are governed by state laws, so a DNR Order from Michigan may not be recognized in another state. If you spend a lot of time in multiple states, it's wise to understand the DNR Order requirements and procedures in each state.

  7. Can I have a DNR Order and still receive other treatments?

    Yes. A DNR Order specifically addresses the use of CPR in the event of cardiac or respiratory arrest. It does not affect other treatments you may receive for comfort, pain relief, or other health conditions. You can continue to receive medical care that aligns with your wishes and goals.

  8. Where should I keep my DNR Order?

    Once your DNR Order is signed, you should keep the original document in a place where it can be easily found in an emergency, such as with your personal documents or on the refrigerator. It’s also a good idea to give copies to your family members, close friends, and healthcare providers to ensure your wishes are known and can be followed.

Common mistakes

Filling out a Michigan Do Not Resuscitate Order form demands attention to detail. Unfortunately, many people make mistakes during this process, potentially causing confusion or invalidating the form. Below are ten common mistakes:

  1. Not including the full legal name - Leaving off a middle name or using a nickname can lead to misidentification.

  2. Incorrect patient information - Entering wrong details, like date of birth or address, can result in processing delays or errors in identification.

  3. Using non-physician signatures - Only a licensed physician can lawfully sign the section designated for physician approval. Family signatures or those of other healthcare providers are not acceptable.

  4. Skipping witness signatures - Forgetting to have the form witnessed makes it non-compliant with Michigan laws. Two witnesses are required for verification.

  5. Witnesses not qualifying - Michigan law specifies who can act as a witness, excluding minors and healthcare providers directly involved in the patient's care.

  6. Not specifying the duration - The form requires a declaration of how long the order should be in effect. Without stating a desired timeframe, it defaults to a standard period that might not align with the patient’s wishes.

  7. Forgetting to date the form - A missing date can make it unclear when the directive came into effect, causing potential legal complications.

  8. Misunderstanding the form's scope - People often confuse this form with broader advanced directives or living wills, not realizing it specifically addresses resuscitation efforts only.

  9. Not consulting with a healthcare provider - Discussing the implications of a Do Not Resuscitate Order with a healthcare provider ensures that the patient and their family understand its impact fully.

  10. Failing to distribute copies appropriately - After completion, it is crucial to provide copies to pertinent parties, including family members, healthcare providers, and, if applicable, the patient’s residential care facility.

To ensure a Michigan Do Not Resuscitate Order form is legally binding and reflects the patient’s wishes accurately, avoiding these mistakes is critical. Proper completion provides peace of mind to all parties involved, knowing that the patient's preferences are documented and will be respected.

Documents used along the form

In handling medical and end-of-life planning, it's paramount to be well-prepared with the necessary legal documents. The Michigan Do Not Resuscitate (DNR) Order form is a crucial document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of a patient's cardiac or respiratory arrest. Alongside this vital document, several other forms and documents play an essential role in ensuring a person's healthcare wishes are respected and followed. Below is a list of seven other forms and documents often used in conjunction with the Michigan DNR Order form.

  • Advance Directive: A legal document that outlines a person’s healthcare preferences, including treatments they do or do not want, in case they become unable to communicate their decisions due to illness or incapacity.
  • Living Will: Serves as a

Similar forms

  • Living Will: Similar to a Do Not Resuscitate (DNR) order, a living will is a legal document that outlines a person’s wishes regarding medical treatment in scenarios where they are unable to communicate their decisions. Both documents provide instructions for medical care, but a living will is broader, covering more situations beyond resuscitation.

  • Health Care Power of Attorney: This document authorizes another individual to make healthcare decisions on behalf of someone if they become unable to do so. Like a DNR, it activates under specific medical conditions, but it encompasses all medical decisions, not just those about resuscitation.

  • Advance Directive: An advance directive is a combination of a living will and a health care power of attorney. It outlines a person’s healthcare preferences and designates a decision-maker. Both DNR orders and advance directives ensure a person’s medical care wishes are known and followed when they can't communicate.

  • Medical Orders for Life-Sustaining Treatment (MOLST): This order provides specific instructions about life-sustaining treatment for individuals with serious health conditions. Like a DNR, a MOLST is used to direct healthcare providers about certain types of medical interventions the patient does or does not want.

  • Physician Orders for Scope of Treatment (POST): Similar to the DNR, the POST form is a medical order that outlines a patient’s preference regarding treatments, including CPR, in the event of a medical emergency. It is designed for patients with serious illnesses or at the end of life.

  • Emergency Medical Services (EMS) Do Not Resuscitate Order: An EMS DNR order is specifically intended to inform emergency personnel not to perform CPR. While similar to a standard DNR, this document is specifically designed for use by emergency services outside of a hospital setting.

  • Five Wishes Document: Five Wishes is a form that lets individuals specify their personal, emotional, and spiritual needs as well as their medical wishes in case they become unable to communicate. It shares similarities with a DNR by addressing medical intervention preferences, but it is broader and also focuses on comfort care and other desires.

  • Durable Power of Attorney for Healthcare: This legal document, similar to a health care power of attorney, allows someone to make healthcare decisions on another's behalf. It includes decisions about refusing or requesting treatment, including life support, mirroring a DNR’s purpose to guide medical treatment based on the patient's wishes.

Dos and Don'ts

Filling out a Do Not Resuscitate (DNR) order form in Michigan is an important process that allows individuals to make their health care wishes known in the event that they can no longer communicate their decisions. Here are some essential dos and don'ts to help guide you through this process:

Do:
  • Read the form thoroughly before beginning to fill it out. Understanding every section will ensure that you complete it accurately.
  • Discuss your wishes with your family, close friends, and healthcare providers. It's important that they understand your decisions regarding resuscitation.
  • Ensure that all information is complete and accurate, including your personal information and any specific instructions.
  • Sign and date the form in the presence of the required witnesses. Michigan law may require these witnesses to meet certain criteria.
  • Keep the original form in a place where it can be easily found in an emergency, such as with your personal documents or in your refrigerator door. Emergency responders are trained to look in these locations.
  • Provide copies of the completed form to your doctor, close family members, and, if applicable, your attorney.
  • Consider wearing a DNR bracelet or carrying a DNR card in your wallet to ensure that your wishes are known even if the document is not immediately available.
Don't:
  • Fill out the form without fully understanding its implications. If you have any questions, it's important to seek advice from a healthcare professional or a lawyer.
  • Use pencil or erasable ink. All entries should be made in permanent ink to ensure they cannot be altered without your consent.
  • Forget to update your DNR order if your wishes change. This will involve completing a new form and ensuring all relevant parties have the latest version.
  • Assume that completing a DNR order is the only step in planning for end-of-life care. Consider also preparing an advance directive or living will, which can provide more comprehensive guidance regarding your healthcare preferences.
  • Leave spaces blank if they are applicable to you. If a section does not apply, it's better to write "N/A" than to leave it empty.

By carefully considering these dos and don'ts, you can ensure that your Michigan Do Not Resuscitate Order accurately reflects your wishes and is legally compliant. Remember, this process is about taking control of your healthcare decisions, so taking the time to do it correctly is critical.

Misconceptions

When discussing the Michigan Do Not Resuscitate (DNR) Order form, there are several common misconceptions that need to be clarified. The intent is to shed light on what a DNR really means in Michigan, dispelling myths and providing accurate information.

  • Only the elderly can have a DNR Order. Many believe that DNR Orders are exclusive to older adults. In reality, any person, regardless of age, can have a DNR Order if they have a terminal illness, a significant risk of death in the near future, or if they wish not to receive CPR under certain circumstances. The decision is based on personal and medical considerations, not age.
  • A DNR Order means you’ll receive no medical treatment. This misunderstanding can cause a lot of stress and confusion. A DNR Order specifically concerns CPR—not other forms of medical treatment. Patients with a DNR Order will still receive other medical care, including pain management, antibiotics, or treatments to improve comfort and health. It simply instructs healthcare providers not to perform CPR if the patient’s breathing or heartbeat stops.
  • Doctors decide if someone gets a DNR Order. Many think it's solely in the hands of doctors to impose a DNR Order. However, this is a decision that typically involves a discussion among the patient (if capable), their family, and their healthcare providers. It's a collective process aimed at honoring the wishes and best interests of the patient. In cases where patients cannot make their own decisions, their legally designated healthcare advocate or family members may be involved in the decision-making process.
  • Having a DNR Order means you’re giving up on life. This is perhaps one of the most hurtful misconceptions. Choosing to have a DNR Order is not about giving up but making a personal decision about the end-of-life care you wish to receive. It’s about maintaining dignity, controlling the situation as much as possible, and focusing on the quality of life.

Understanding the facts behind the DNR Order can help patients and their families navigate their healthcare options more confidently, ensuring that decisions align with personal values and medical needs.

Key takeaways

Filling out and using the Michigan Do Not Resuscitate (DNR) Order form is an important process for those who wish to express their preferences about life-saving treatments. The DNR Order, once completed and properly signed, informs healthcare providers not to perform cardiopulmonary resuscitation (CPR) in the event the patient's breathing stops or heart ceases beating. Understanding the key takeaways of this process can help ensure one's wishes are respected. Here are five crucial points to consider:

  • Eligibility requirements must be met: The Michigan DNR Order is designed for specific individuals who wish to forego resuscitation efforts due to a terminal illness or other health considerations. It's important to discuss eligibility with a healthcare provider to ensure that this option aligns with the patient's medical condition and overall care goals.
  • Completion requires specific steps: Completing the DNR Order form demands attention to detail. All sections of the form must be filled out accurately, ensuring that patient information, healthcare provider details, and signatures are properly documented. This meticulousness ensures the document's legal validity and enforceability.
  • Signature of the patient and witnesses are crucial: For a DNR Order to be considered valid, it must be signed by the patient or the patient's legally authorized representative, if the patient is unable to sign. Additionally, the signature of two witnesses or a notary public is required. These signatures confirm the patient's wishes are voluntarily and clearly expressed.
  • Accessibility of the document is critical: Once signed, the DNR Order should be kept in a location where it can be easily accessed by family members, caregivers, and healthcare providers. In emergency situations, the availability of the DNR Order can swiftly communicate the patient's preferences to first responders or hospital staff.
  • Revocation process: It is important to understand that the patient or their legally authorized representative has the right to revoke the DNR Order at any time. This revocation can be done through a verbal or written statement, and it is important to communicate this change to all relevant parties as soon as possible to ensure that the patient's current wishes are known and followed.
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