Arizona PDF Forms

Arizona PDF Forms

Homepage Attorney-Verified Do Not Resuscitate Order Document for the State of Arizona
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In Arizona, the Do Not Resuscitate (DNR) Order form plays a crucial role in ensuring that individuals' medical preferences are respected in emergency situations. This form allows patients to communicate their wishes regarding resuscitation efforts in the event of a cardiac arrest or respiratory failure. It is essential for individuals, especially those with terminal illnesses or severe health conditions, to understand how this form works and the implications of signing it. The DNR Order must be completed and signed by a physician and should be readily available, typically kept with the patient’s medical records or on their person. Additionally, family members and caregivers should be informed of the existence of the DNR to avoid confusion during critical moments. Understanding the DNR form empowers individuals to make informed decisions about their end-of-life care, ensuring that their values and desires are honored when they are unable to speak for themselves.

Guide to Writing Arizona Do Not Resuscitate Order

Filling out the Arizona Do Not Resuscitate Order form is an important step in ensuring that your healthcare preferences are respected. Once you have completed the form, it should be signed and shared with your healthcare providers and family members. This helps to ensure that everyone is aware of your wishes and can act accordingly in a medical emergency.

  1. Obtain the Arizona Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
  2. Carefully read the instructions on the form to understand its purpose and requirements.
  3. Fill in your personal information, including your full name, date of birth, and address.
  4. Designate a healthcare representative, if desired. This person will help communicate your wishes if you are unable to do so.
  5. Indicate your preferences regarding resuscitation. This section will require you to select options that reflect your wishes.
  6. Sign and date the form. This step is crucial, as your signature verifies that you understand and agree to the contents of the document.
  7. Have the form witnessed by two individuals who are not related to you and who do not stand to gain from your estate. Their signatures will validate your decision.
  8. Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider, family members, and anyone else involved in your care.

Common Questions

What is a Do Not Resuscitate (DNR) Order in Arizona?

A Do Not Resuscitate Order is a legal document that allows a person to express their wishes regarding resuscitation efforts in the event of a medical emergency. In Arizona, this order indicates that if a person's heart stops beating or they stop breathing, medical personnel should not perform cardiopulmonary resuscitation (CPR) or other life-saving measures. It is an important tool for individuals who wish to avoid aggressive medical interventions at the end of life.

Who can request a DNR Order in Arizona?

In Arizona, a DNR Order can be requested by individuals who are at least 18 years old and have the capacity to make their own medical decisions. Additionally, a legal guardian or an agent designated under a healthcare power of attorney may also request a DNR Order on behalf of someone who is unable to do so.

How do I obtain a DNR Order in Arizona?

To obtain a DNR Order, you must complete the official Arizona DNR form. This form can typically be acquired from healthcare providers, hospitals, or online through state health department resources. Once completed, the form must be signed by the individual and a physician to be valid. It is important to discuss your wishes with your doctor before filling out the form.

Where should I keep my DNR Order?

Once you have completed and signed your DNR Order, it is crucial to keep it in a place where it can be easily accessed by medical personnel. Many people choose to keep a copy in their medical records, with their family members, or in a visible location at home. Some individuals also carry a wallet card that indicates they have a DNR Order.

Can I change or revoke my DNR Order?

Yes, you can change or revoke your DNR Order at any time. If you decide to do so, it is important to notify your healthcare provider and ensure that any new documents are properly completed and signed. Make sure to distribute the updated order to anyone who may need to know about your wishes, including family members and medical personnel.

Does a DNR Order apply outside of a hospital setting?

Yes, a DNR Order is valid in both hospital and out-of-hospital settings in Arizona. However, it is important to ensure that the order is clearly documented and accessible to emergency medical personnel. In some cases, additional documentation may be required for out-of-hospital situations.

What happens if I do not have a DNR Order?

If you do not have a DNR Order in place and experience a medical emergency, healthcare providers are required to perform life-saving measures such as CPR. This is done regardless of your wishes unless there is a clear indication that you do not want such interventions.

Will having a DNR Order affect my medical care?

Having a DNR Order does not mean that you will receive any less medical care. It simply specifies your wishes regarding resuscitation efforts. Healthcare providers will continue to offer appropriate treatments and interventions that align with your overall healthcare goals and preferences.

Is a DNR Order the same as a living will?

No, a DNR Order and a living will are not the same, although they are related. A DNR Order specifically addresses resuscitation efforts in emergencies, while a living will outlines your preferences for medical treatment and end-of-life care more broadly. Both documents can work together to ensure that your healthcare wishes are honored.

Do I need a lawyer to create a DNR Order?

No, you do not need a lawyer to create a DNR Order in Arizona. The process is designed to be straightforward, allowing individuals to express their wishes regarding resuscitation without needing legal assistance. However, consulting with a healthcare professional or a legal expert can provide additional guidance and ensure that your documents are completed correctly.

Dos and Don'ts

When filling out the Arizona Do Not Resuscitate (DNR) Order form, it is essential to approach the task with care and consideration. Here are five important dos and don'ts to keep in mind:

  • Do ensure that you understand the implications of a DNR order before completing the form.
  • Do discuss your wishes with your healthcare provider to ensure they are clearly understood.
  • Do sign and date the form in the presence of a witness, if required.
  • Don't fill out the form hastily; take your time to consider your decisions.
  • Don't forget to provide copies of the completed form to your healthcare team and family members.

Similar forms

The Arizona Do Not Resuscitate (DNR) Order form shares similarities with the Advance Directive. An Advance Directive is a legal document that allows individuals to outline their healthcare preferences in advance. This document can include instructions on various medical treatments, including resuscitation efforts. Like the DNR, it serves to communicate a person's wishes regarding life-sustaining measures, ensuring that healthcare providers respect those choices when the individual is unable to speak for themselves.

Another document akin to the DNR is the Living Will. A Living Will specifically addresses an individual's wishes regarding end-of-life care. It details the types of medical treatments a person does or does not want if they become terminally ill or incapacitated. Both the Living Will and the DNR focus on the patient's preferences, providing clarity to healthcare providers and family members during critical times.

The Medical Power of Attorney (MPOA) is also comparable to the DNR. This document allows individuals to appoint someone to make medical decisions on their behalf if they are unable to do so. While the DNR focuses solely on resuscitation efforts, the MPOA can cover a broader range of medical decisions. Both documents emphasize the importance of patient autonomy and ensure that healthcare choices align with an individual’s values.

Similar to the DNR is the Physician Orders for Life-Sustaining Treatment (POLST). The POLST form translates a patient’s wishes regarding treatment into actionable medical orders. It is designed for individuals with serious illnesses or advanced frailty. Like the DNR, the POLST is intended to guide healthcare providers in delivering care that aligns with the patient’s desires, especially in emergency situations.

The Comfort Care Order is another document that resembles the DNR. This order emphasizes providing comfort and palliative care rather than aggressive life-saving treatments. It is often used in hospice or end-of-life scenarios. Both the Comfort Care Order and the DNR prioritize the quality of life and respect the individual’s wishes regarding medical interventions.

The Do Not Intubate (DNI) order is closely related to the DNR. A DNI specifically instructs healthcare providers not to use intubation or mechanical ventilation to assist with breathing. While the DNR focuses on resuscitation efforts, the DNI addresses a specific aspect of life support. Both documents aim to honor the patient’s preferences regarding life-sustaining treatments.

The Authorization for Disposition of Remains is another document that can be linked to the DNR. This form allows individuals to specify their wishes regarding the handling of their remains after death. While it does not directly address medical treatment, it complements the DNR by ensuring that a person’s preferences extend beyond their medical care. Both documents reflect an individual’s autonomy and desire to control their end-of-life decisions.

Lastly, the Health Care Proxy is similar to the DNR in that it designates someone to make healthcare decisions on behalf of an individual. This document is particularly useful when a person becomes incapacitated. While the DNR focuses on resuscitation preferences, the Health Care Proxy encompasses a wider range of medical decisions. Both documents serve to ensure that a patient’s wishes are honored, even when they cannot advocate for themselves.

Key takeaways

When considering the Arizona Do Not Resuscitate Order (DNR) form, it's essential to understand its significance and how to complete it correctly. Here are some key takeaways to keep in mind:

  • Understand the Purpose: The DNR order allows individuals to express their wishes regarding resuscitation efforts in case of a medical emergency. It ensures that your preferences are respected by healthcare providers.
  • Eligibility: To complete the DNR form, you must be an adult (18 years or older) and capable of making your own medical decisions. If you are unable to do so, a legally authorized representative may complete it on your behalf.
  • Signature Requirements: The form must be signed by you or your representative and a physician. This signature validates your wishes and ensures that healthcare professionals are aware of your DNR status.
  • Keep Copies Accessible: Once completed, make several copies of the DNR order. Share them with your healthcare provider, family members, and anyone involved in your care to ensure your wishes are known and can be honored.

Common mistakes

  1. Not Understanding the Form's Purpose: Many individuals fill out the Arizona Do Not Resuscitate Order (DNR) form without fully grasping its significance. It is essential to recognize that this document indicates a person's wish to forgo resuscitation in case of cardiac or respiratory arrest. Failing to understand this can lead to unintended consequences.

  2. Inadequate Communication with Healthcare Providers: A common mistake is not discussing the DNR decision with healthcare providers. Open communication ensures that medical staff are aware of the patient's wishes and can provide appropriate care. Without this dialogue, misunderstandings may arise during critical moments.

  3. Incomplete or Incorrect Information: Filling out the form with missing or inaccurate details is another frequent error. Essential information, such as the patient's name, date of birth, and signature, must be clearly stated. Omissions can render the document invalid or lead to confusion during emergencies.

  4. Not Informing Family Members: Some individuals neglect to inform their family about the DNR order. It is crucial for family members to be aware of the patient's wishes. This knowledge can help prevent emotional distress and conflicts during a medical crisis.

  5. Failure to Review and Update the Order: Life circumstances change, and so can a person's healthcare preferences. Failing to regularly review and update the DNR order can lead to situations where the document no longer reflects the individual's current wishes. Regular check-ins with healthcare providers are advisable to ensure alignment.

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Arizona Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is established in accordance with Arizona state law, specifically A.R.S. § 36-3201 to § 36-3205.

Please complete the information below:

  • Patient's Full Name: _______________________________
  • Date of Birth: _______________________________
  • Address: ______________________________________
  • City: _______________________ State: ___________ ZIP Code: __________
  • Emergency Contact Name: _______________________
  • Emergency Contact Phone Number: ________________

Order Declaration:

I, the undersigned, declare that I do not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. I understand the implications of this decision.

Signature of Patient: ___________________________

Date: ___________________________

If the patient is unable to sign, provide the name of the legal representative:

Name: _______________________________

Relationship to Patient: ______________________

Signature of Legal Representative: ___________________________

Date: ___________________________

This order is valid unless revoked or amended. A copy of this order should be provided to the patient's healthcare provider.

Witness Signature: ___________________________

Date: ___________________________

Form Specs

Fact Name Description
Definition The Arizona Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation efforts in the event of cardiac or respiratory arrest.
Governing Law The DNR Order is governed by Arizona Revised Statutes, specifically ARS § 36-3201 through § 36-3209.
Eligibility Any adult or emancipated minor can complete a DNR Order. It must be signed by a physician and the patient or their authorized representative.
Form Availability The DNR Order form is available through healthcare providers, hospitals, and online resources provided by the Arizona Department of Health Services.
Revocation Individuals can revoke a DNR Order at any time. This can be done verbally or by destroying the form.
Emergency Medical Services (EMS) Compliance Emergency medical personnel are required to honor a valid DNR Order, ensuring that the patient's wishes are respected in emergency situations.