- Document Name:
- UNIFORM DO-NOT-RESUSCITATE (DNR) ADVANCE DIRECTIVE
- Where do you get the form
- A physician must complete the form on your behalf. To obtain a copy of the IDPH Uniform DNR Advance Directive, you may request one from your health-care professional or facility. Copies also are available on the Illinois Department of Public Health’s Web site located at www.idph.state.il.us/public/books/advin.htm.
- Who signs the form
- The form is signed by the physician, the patient, and two witnesses and printed on brightly cooolored ORANGE paper.
- Patient Identification
- There is no requirement for a patient to wear a DNR identification bracelet. EMS will honor a DNR form signed by a physician, patient and 2 witnesses.
- How do you obtain a DNR bracelet
- If you want to wear a DNR bracelet, you can order one from one of the linke listed below.
- Revoking a DNR
- The DNR order can be revoked in a variety of ways, such as by writing “VOID” in large letters across the front of the form. If you revoke a DNR order, you also should tell your family members, as well as each health-care professional and provider that has received a copy of the order. You may then choose not to have a DNR order, or you may choose to complete a new DNR order reflecting any changes you wish .
- Photocopy
- Photocopies of a completed IDPH Uniform DNR Advance Directive are valid.
- State info link
- http://tinyurl.com/ltm527
- State statute link:
- http://tinyurl.com/ddgby4
- Other links
- http://www.vialoflife.com/
- DNR Bracelet links
- You can elect to purchase a DNR bracelet at these links.
- Special Notes
- Order a Vial of Life decal for your front door. The decal informs Emergency Medical Services team a DNR has been prepared and can be found in your refrigerator. The original DNRO order MUST be printed on ORANGE paper, 8 ½ by 11.
Tagged as: DNR form, DNR Order, do not resuscitate (DNR), do not resusitate, Illinois do not resuscitate order
- Document Name
- EMS Do Not Resuscitate and Medical Care Order.
- Where do you get the form
- A physician must complete the form on your behalf. You can print out the form: http://www.miemss.org/home/Portals/0/Docs/OtherPDFs/DNRorder_form.pdf
- Who signs the form
- The form is signed by the physician, the patient, and two witnesses and printed on brightly cooolored ORANGE paper.
- Patient Identification
- There is no requirement for a patient to wear a DNR identification bracelet. EMS will honor a DNR form signed by a physician, patient and 2 witnesses.
- How do you obtain a DNR bracelet
- The DNR form includes information about ordering a DNR bracelet. If a vinyl bracelet is to be used, have the physician sign the bracelet inserts at the bottom of the EMS/DNR. If a metal bracelet or necklace is desired contact Medic Alert® at 1-800-432-5378. They will send you the application and information. They will require a copy of this order in order to process your request.
If a vinyl bracelet will be used, be sure the insert has been completed and signed, tear the bracelet insert off of the original form, fold it, trim it along the dashed line, and insert it in the vinyl EMS/DNR bracelet that has been provided. The bracelet may be worn about the wrist, hung from a necklace, or pinned to clothing. - Revoking a DNR
- An EMS/DNR Order may be revoked at any time by the patient’s request for resuscitation made directly to responding emergency medical services personnel OR by the physical cancellation or destruction of al l EMS/DNR Order forms, bracelets, and necklaces with the consent of the patient or the authorized decision maker signing the EMS/DNR Order. Destruction of an EMS/DNR Order, bracelet, or necklaces without consent carries penalties under the Health Care Decision Act.
- Photocopy
- Photocopies of a completed DNR form are valid.
- State info link
- http://www.miemss.org/home/PublicInformation/DNRDoNotResuscitate/tabid/118/Default.aspx
- Other links
- http://www.vialoflife.com/
- DNR Bracelet links:
- You can elect to purchase a DNR bracelet at these links.
- Special Notes
- Order a Vial of Life decal for your front door. The decal informs Emergency Medical Services team a DNR has been prepared and can be found in your refrigerator.
Tagged as: DNR bracelet, DNR form, DNR Order, do not resuscitate (DNR), do not resusitate, Maryland do not resuscitate order
