Attorney-Verified Do Not Resuscitate Order Form for Hawaii State Edit Form

Attorney-Verified Do Not Resuscitate Order Form for Hawaii State

A Hawaii Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form ensures that healthcare providers respect the patient's preferences concerning life-sustaining treatments. Understanding and completing this form is essential for anyone wishing to communicate their end-of-life care choices clearly.

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In Hawaii, the Do Not Resuscitate (DNR) Order form plays a crucial role in ensuring that individuals can express their wishes regarding medical treatment in emergency situations. This form is designed for patients who wish to forgo resuscitation efforts, such as CPR, in the event of cardiac or respiratory arrest. It empowers individuals to make informed decisions about their end-of-life care, reflecting their personal values and preferences. The DNR Order must be completed and signed by a qualified physician, and it requires the patient’s or their legal representative’s consent. Additionally, it is essential for the form to be readily accessible to medical personnel, ensuring that healthcare providers can honor the patient's wishes without delay. Understanding the implications of this document is vital for anyone considering it, as it not only addresses immediate medical interventions but also promotes discussions about broader healthcare goals and values.

Sample - Hawaii Do Not Resuscitate Order Form

Hawaii Do Not Resuscitate (DNR) Order Template

This document serves as a Do Not Resuscitate (DNR) Order in compliance with the Hawaii Revised Statutes. It is a legally binding declaration indicating that the individual named herein refuses any form of cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.

Personal Information:

  • Full Name: __________________________
  • Date of Birth: ________________________
  • Address: _____________________________
  • City: ________________________________
  • State: Hawaii
  • Zip Code: ___________________________

This order respects the wishes of the individual, ensuring that they receive care that aligns with their values and desires, particularly towards the end of life. It does not extend to other forms of medical intervention that may be necessary for the comfort and care of the individual.

Statement of Declaration:

I, ________[Patient's Name]________, hereby declare that this document reflects my explicit wishes not to receive cardiopulmonary resuscitation (CPR) in the event that my breathing or heart stops. This document is made in accordance with the laws of the State of Hawaii.

Physician Information:

  • Physician's Name: ______________________
  • License Number: ________________________
  • Address: _______________________________
  • City: __________________________________
  • State: Hawaii
  • Zip Code: _____________________________
  • Phone Number: _________________________

The undersigned physician affirms that the patient has been fully informed of the nature and consequences of a DNR order and fully understands that this order will prevent the administration of CPR in the event of a cardiac or respiratory arrest.

Patient's Signature: ___________________________ Date: _______________

Physician's Signature: __________________________ Date: _______________

This document should be printed and kept in a location that is immediately accessible to first responders and family members. It is also advised to have discussions with family, caregivers, and healthcare providers to ensure that they are aware of and understand this DNR order.

Document Overview

Fact Name Details
Definition A Do Not Resuscitate (DNR) order is a legal document that indicates a person's wish not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Governing Law The DNR order in Hawaii is governed by Hawaii Revised Statutes § 327-1 through § 327-3.
Eligibility Any adult can create a DNR order, provided they are capable of making their own medical decisions.
Required Signatures A DNR order must be signed by the patient and a physician to be valid.
Form Availability The DNR order form is available through healthcare providers, hospitals, and the Hawaii Department of Health.
Emergency Medical Services Emergency medical personnel must honor a valid DNR order and refrain from performing CPR.
Revocation A DNR order can be revoked at any time by the patient or their legal representative.
Communication It is essential to communicate the existence of a DNR order to family members and healthcare providers.
Location of Form The DNR order should be kept in an easily accessible location, such as a medical file or with personal identification.
Advance Directives A DNR order is part of a broader category of advance directives, which outline a person's healthcare preferences.
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