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The Kansas Do Not Resuscitate Order form serves as a critical tool for individuals wishing to exercise control over their medical treatment in situations where they might not be able to make their wishes known due to incapacity or near the end of life. This form, often abbreviated as a DNR, is a legally binding document that communicates a person's wish to forego resuscitative measures such as CPR in the event their breathing stops or their heart ceases to beat. Its existence helps to ensure that healthcare providers are aware of and respect the individual's preferences regarding life-sustaining treatments. Each state has its own specific requirements and procedures for the creation and implementation of DNR orders, and Kansas is no exception. Understanding the legal implications, the process of obtaining a DNR order, and its role within the broader context of healthcare planning in Kansas are essential for individuals and their families making informed decisions about end-of-life care.

Example - Kansas Do Not Resuscitate Order Form

This Kansas Do Not Resuscitate Order (DNR) template is created in accordance with the Kansas "Do Not Resuscitate" legislation, allowing individuals to refuse certain life-sustaining treatments in the event of a cardiac or respiratory arrest. Ensure that this document is completed under the guidance of a qualified healthcare provider and in cooperation with the patient or their legally appointed health care decision-maker.

Patient Information:

  • Full Name: _____________________________
  • Date of Birth: __________________________
  • Address: _______________________________
  • City: _______________ State: KS Zip: ________
  • Phone Number: ___________________________

Medical Provider Information:

  • Provider's Name: _________________________
  • License Number: _________________________
  • Address: ________________________________
  • City: _______________ State: KS Zip: ________
  • Phone Number: ____________________________

Declaration:

I, _____________________ (the "Patient"), understand that this Do Not Resuscitate Order directs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event my heart stops beating or I stop breathing. This decision has been made voluntarily and with a full understanding of its significance. I understand that this does not prevent the provision of other types of medical care, including pain relief, nutrition, and hydration as deemed appropriate.

Legal Guardian or Healthcare Power of Attorney Information (if applicable):

  • Full Name: _____________________________
  • Relationship to Patient: _________________
  • Address: _______________________________
  • City: _______________ State: KS Zip: ________
  • Phone Number: ___________________________

Acknowledgement by Healthcare Provider:

I, _____________________ (the "Provider"), certify that I have discussed this Do Not Resuscitate Order with the patient and/or the patient's legally authorized representative. I have explained the nature, significance, and consequences of a DNR order, and I am satisfied that the patient/representative fully understands and has voluntarily agreed to this DNR order.

Signatures:

  1. Patient Signature: _________________________ Date: __________
  2. Legal Guardian/Healthcare Power of Attorney Signature (if applicable): _________________________ Date: __________
  3. Healthcare Provider Signature: _________________________ Date: __________

Form Characteristics

Fact Number Fact Detail
1 The Kansas Do Not Resuscitate (DNR) Order Form is utilized to inform medical personnel not to perform CPR (cardiopulmonary resuscitation) on the patient.
2 This form must be completed by a licensed physician to be valid.
3 The form is a part of a patient's medical records and should be easily accessible to healthcare providers.
4 Consent from the patient, or their legal guardian if the patient is unable to make decisions, is necessary to issue a DNR order.
5 Kansas law requires clear evidence of the patient's wishes regarding resuscitation for a DNR order to be implemented.
6 The DNR order can be revoked by the patient at any time through a verbal or written statement to a healthcare provider.
7 Healthcare facilities in Kansas must have protocols in place for recognizing and following DNR orders.
8 A DNR order does not affect the provision of other medical treatments beyond CPR.
9 The presence of a DNR order does not influence decisions regarding the patient's care in situations unrelated to resuscitation.
10 Governing laws for DNR orders in Kansas include state statutes and regulations pertaining to end-of-life decisions and patient rights.

Kansas Do Not Resuscitate Order - Usage Guide

When completing a Do Not Resuscitate (DNR) Order form in Kansas, you are taking a vital step in managing your health care preferences. This document communicates your wish not to have cardiopulmonary resuscitation (CPR) performed in the event your heart stops or you stop breathing. The process needs to be handled with care to ensure your wishes are clearly stated and legally recognized. Below, you'll find straightforward instructions to guide you through filling out your Kansas DNR Order form.

  1. Start by gathering your personal information, including your full legal name, date of birth, and address. This ensures your identity is clear on the form.
  2. Locate the Kansas DNR Order form. This can typically be found online through the Kansas Department of Health and Environment's website or at a healthcare provider's office.
  3. Read the form carefully. Understanding every section is crucial before you start filling it out to ensure all your responses accurately represent your wishes.
  4. Enter your personal information in the designated areas on the form. Make sure to write legibly if filling out by hand or to type your responses if the form is fillable online.
  5. Discuss your wishes with your healthcare provider. It's important for them to understand your desires regarding CPR and to ensure that your health condition qualifies under state law for a DNR Order.
  6. Your healthcare provider must sign the form. Their signature is essential as it validates your DNR Order according to Kansas laws.
  7. If required, have a witness sign the form. Some versions of the form may require a witness to your signature, confirming your identity and your voluntary decision to issue a DNR Order.
  8. Keep the original document in a safe but accessible place. Inform your family members, healthcare proxy (if you have one), and your primary healthcare provider where the DNR Order is stored.
  9. Consider carrying a DNR identification, such as a bracelet or a card, that indicates you have a DNR Order in place. This can be particularly helpful in emergency situations when you might not be able to communicate your wishes.

After completing and signing your Kansas DNR Order form, the next steps involve communication and safekeeping of the document. It's important to let those close to you know about your decision and where the document can be found. Additionally, consider reviewing the DNR Order periodically with your healthcare provider to ensure it continues to reflect your current wishes and health status. Staying proactive about your health care decisions helps ensure your preferences are honored in critical moments.

Get Clarifications on Kansas Do Not Resuscitate Order

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

A Do Not Resuscitate Order (DNR) in Kansas is a medical order that tells health care providers not to perform cardiopulmonary resuscitation (CPR) if a person's breathing stops or if their heart stops beating. It is intended for individuals who wish to avoid aggressive life-saving measures in favor of allowing natural death.

How can I obtain a DNR order in Kansas?

To obtain a DNR order in Kansas, you must discuss your health care wishes with a Kansas-licensed physician. The physician can issue a DNR order based on this conversation. The order becomes part of your medical record and should also be shared with your family and other health care providers.

Do I need to carry the DNR order with me?

Yes, it is highly recommended that you carry the DNR order with you or ensure it is placed in a location where emergency medical personnel can easily find it. In Kansas, patients often keep a copy of their DNR order on their refrigerator or wear it as an easily visible bracelet or necklace.

Can a DNR order be revoked?

A DNR order can be revoked at any time by the person it pertains to, a legally authorized decision-maker, or the physician. Revocation can occur orally or in writing. It's important to notify all relevant parties, including physicians and family members, if a DNR is revoked.

Is it necessary for a lawyer to be involved in the creation of a DNR order?

No, a lawyer is not required to be involved in the creation of a DNR order in Kansas. The most important aspect is having a detailed conversation with your physician who is familiar with your medical condition and health care wishes. However, consulting a lawyer can be beneficial if you're also considering other estate planning documents.

Does the DNR order apply outside of a hospital setting?

Yes, in Kansas, a DNR order applies both in hospital settings and in other settings, such as at home. Emergency medical services (EMS) personnel are trained to recognize and respect these orders when presented to them.

Are there age restrictions for a DNR order in Kansas?

No, there are no age restrictions for a DNR order in Kansas. Any person, regardless of age, can obtain a DNR order if they, along with their physician, decide it is in their best interest based on their health condition and personal wishes.

What should I do if my family disagrees with my decision to have a DNR order?

Discussions about end-of-life care can be difficult. It's recommended that you have an open and honest conversation with your family about your wishes. You might also consider involving a healthcare professional, such as a social worker or your physician, to help facilitate the discussion and provide clarity on your decision.

Can a DNR order be modified once it is in place?

Yes, a DNR order can be modified. If you or your physician decides that changes are needed, a new DNR order must be completed to reflect these changes. It is crucial to communicate any modifications to all involved parties to ensure your wishes are clearly understood and followed.

Common mistakes

When filling out the Kansas Do Not Resuscitate (DNR) Order form, attention to detail is critical. However, some common mistakes can hinder the process, potentially affecting its enforceability. It's important to navigate these forms carefully to ensure they reflect the wishes of the person involved accurately.
  1. Not verifying the patient's full legal name and date of birth: It's essential to double-check that the patient's full legal name and date of birth are correctly listed on the form. Any discrepancy between the name on the DNR and any identification documents can lead to confusion and delays in an emergency.

  2. Skipping the signature requirements: The Kansas DNR form requires signatures from both the patient (or their legally authorized representative, if the patient is unable) and the physician. Sometimes, people either forget to include all necessary signatures or do not follow the specific requirements for witnessing the signatures, which could invalidate the document.

  3. Omitting the physician's details: The form must include the name, contact information, and license number of the physician who signs the DNR order. Leaving this information incomplete could question the validity of the DNR order.

  4. Failing to communicate with family members or caregivers: Even if a DNR order is correctly filled out and signed, if the patient's family members or caregivers are unaware of its existence or the specific wishes outlined, it can lead to distressing situations. Communication ensures that everyone involved in the patient's care understands their wishes.

  5. Not updating the DNR order: Health conditions and preferences can change over time. A DNR form that reflects decisions made years ago may not accurately represent the current wishes of the patient. Regular reviews and updates to the document are necessary to ensure it aligns with the patient's current preferences.

Each of these steps is crucial in ensuring the DNR order serves its intended purpose—respecting the wishes of the patient. Attention to the smallest detail can make a significant difference in moments that matter most.

Documents used along the form

Preparing for medical emergencies and end-of-life care often requires more than a single document. In Kansas, alongside a Do Not Resuscitate (DNR) Order form, individuals and their families may consider including other legal forms and documents that provide comprehensive guidance on their healthcare preferences and personal affairs. Each of these documents plays a crucial role in ensuring that the individual's wishes are respected and clearly communicated to healthcare providers, family members, and legal representatives.

  • Advance Directive for Health Care - This document combines a Living Will and a Health Care Power of Attorney. It allows individuals to outline their preferences for medical treatment and end-of-life care, and to appoint someone to make healthcare decisions on their behalf if they become unable to do so.
  • Power of Attorney for Finances - A legal document granting a trusted person authority to handle financial transactions on behalf of the individual. This capacity can be comprehensive or limited to specific actions.
  • Living Will - A written statement detailing a person's desires regarding medical treatment in circumstances in which they are no longer able to express informed consent, especially concerning end-of-life care.
  • Medical Records Release Form - Authorizes the disclosure of the individual's health information between healthcare providers, or to another person designated by the individual, facilitating continuity of care.
  • Last Will and Testament - Dictates how an individual's property and affairs should be handled after death. It is crucial for ensuring that assets are distributed according to the deceased's wishes.
  • Organ Donation Registration - A document indicating the individual's consent to donate their organs and tissues upon death. This can be part of a driver's license or a separate registrar form.
  • Portable Medical Order (POLST) - For seriously ill or frail individuals, a POLST form translates their treatment preferences into actionable medical orders, applicable across healthcare settings.
  • Hospital Visitation Authorization - Allows individuals to designate who can visit them in the hospital, ensuring that their loved ones have access in restricted or sensitive situations.
  • Durable Power of Attorney for Health Care Decisions - Similar to the Health Care Power of Attorney, this document remains in effect even if the individual becomes mentally incompetent, ensuring that their healthcare proxy can make decisions for them.
  • Funeral Planning Declaration - Enables individuals to outline their preferences for their funeral arrangements, including burial or cremation, type of ceremony, and other specific wishes.

Together, these forms and documents create a safety net around the individual, ensuring that their healthcare, financial, and personal wishes are known and respected. By planning ahead and communicating clearly with loved ones and healthcare providers, individuals can relieve their families of the burden of making difficult decisions during times of crisis or grief. Understanding and preparing these documents in advance can provide peace of mind and a sense of security for everyone involved.

Similar forms

The Kansas Do Not Resuscitate Order form is similar to several other documents used within the United States to manage healthcare preferences, particularly at the end of life or in emergency medical situations. These documents, while serving unique purposes, share the common goal of respecting the healthcare wishes of individuals when they might not be able to communicate these wishes themselves.

Living Wills: Similar to the Do Not Resuscitate (DNR) orders, living wills are documents that specify an individual's preferences regarding medical treatments in various scenarios, often including end-of-life care. While a DNR specifically addresses the use of CPR and other resuscitative measures, a living will can encompass a broader range of interventions, such as mechanical ventilation, artificial nutrition, and hydration. Both documents serve to communicate an individual's healthcare choices ahead of time, thus relieving family members and healthcare providers of making these difficult decisions without guidance.

Healthcare Power of Attorney (POA): This document is akin to a DNR order in that it designates another individual to make healthcare decisions on one's behalf when they are unable to do so for themselves. The scope of a Healthcare POA is broader, covering a wide range of medical decisions beyond resuscitation. Both the Healthcare POA and the DNR order emphasize the importance of having one's healthcare preferences honored, but the POA includes the appointment of a specific person (often a trusted family member or friend) to advocate for these preferences.

Physician Orders for Life-Sustaining Treatment (POLST): The POLST form goes beyond the DNR order by providing detailed instructions about a range of life-sustaining treatments, in addition to CPR. This includes preferences for antibiotics, artificial nutrition, and other interventions. While a DNR order applies mainly in the event of a cardiac or respiratory arrest, the POLST form is intended to guide emergency medical personnel and other healthcare providers in a wider variety of situations where the patient's condition is life-threatening. Both documents are critical for ensuring that healthcare interventions align with the patient's values and wishes.

Dos and Don'ts

When filling out the Kansas Do Not Resuscitate (DNR) Order form, it is essential to follow specific guidelines to ensure that the document is legally binding and accurately represents the wishes of the person it concerns. Below is a list of things to do and not to do during this process:

  • Do ensure that the person for whom the DNR order is intended fully understands the implications of the document. It's crucial that they are aware that in the event of a cardiac or respiratory arrest, resuscitation will not be attempted.
  • Do consult with a healthcare provider before completing the form. A physician, nurse practitioner, or physician assistant can provide valuable insights and clarity on the medical aspects of the DNR order.
  • Do use black or blue ink when filling out the form. This makes the document clearer and more durable for long-term filing.
  • Do ensure that all required parties sign and date the form. This usually includes the patient (or their legal representative) and the attending physician.
  • Don't leave any sections of the form blank. If a question does not apply, write "N/A" (not applicable) so that there is no ambiguity about whether a section was overlooked.
  • Don't use correction fluid or tape. Mistakes should be crossed out neatly, and the correct information should be clearly written next to it. Initial any changes to indicate that they were made intentionally.
  • Don't forget to review the form thoroughly before finalizing it. Double-check all the details for accuracy and completeness.
  • Don't delay submitting the completed form to the appropriate healthcare provider or medical records department. A delay can result in the document not being readily available in an emergency, which could lead to unwanted medical interventions.

Misconceptions

When it comes to the Kansas Do Not Resuscitate (DNR) Order form, there are several misunderstandings that often cloud people's perceptions. Knowing what these misconceptions are can help clear up confusion and ensure that individuals make informed decisions about their healthcare. Here are seven common misconceptions:

  • The DNR order applies to all medical treatments. Actually, a DNR order only applies to cardiopulmonary resuscitation (CPR). It does not prevent healthcare providers from offering other life-sustaining treatments or interventions unless specified otherwise in an advance directive.
  • Only the elderly or terminally ill can have a DNR order. This is not true. Anyone, regardless of age or health status, can request a DNR order if they do not wish to receive CPR in the event their heart or breathing stops. The decision should be based on personal wishes, values, and discussions with healthcare professionals.
  • A DNR order is permanent and cannot be changed. In reality, a DNR order can be revoked or updated at any time by the individual or their legal representative. Life circumstances and preferences can change, and so too can decisions about resuscitation.
  • Doctors decide when to implement a DNR order. The truth is, a DNR order is based on the patient's or their legal guardian's wishes, not the doctor's. While a doctor can provide advice, the final decision rests with the patient or their legally authorized representative.
  • A DNR order must be notarized to be valid. Kansas laws do not require a DNR order to be notarized. It must, however, be signed by the patient (or their legal representative) and the physician to be considered valid and enforceable.
  • A DNR order is automatically recognized in all settings. This misconception can lead to confusion. A DNR order may not be automatically recognized outside of a hospital setting, such as in a nursing home or by emergency medical services, without proper communication and documentation in place.
  • Having a DNR order means you will receive lower quality care. This is entirely false. A DNR order specifies a person's wishes regarding CPR only. It does not affect the quality of care provided by healthcare professionals in treating other medical conditions or in providing comfort and support.

Understanding these misconceptions about the Kansas DNR Order form can empower individuals to make more informed decisions regarding their end-of-life care and ensure their wishes are respected. It's essential to have open and honest discussions with healthcare providers and loved ones about these decisions.

Key takeaways

When it comes to making important healthcare decisions, particularly around end-of-life care, understanding and properly executing a Do Not Resuscitate Order (DNR) is crucial. In Kansas, like in many states, the DNR order plays a significant role in directing healthcare professionals about the preferences in life-sustaining treatments. Here are ten key takeaways for filling out and using the Kansas Do Not Resuscitate Order form:

  1. Understand what a DNR is: A DNR is a legal document that tells healthcare providers not to perform cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing.
  2. Consult with a healthcare provider: Before filling out the form, have a thorough discussion with your doctor or healthcare provider to understand the implications of a DNR order and ensure it aligns with your healthcare wishes.
  3. Fill out the form accurately: Make sure all information on the DNR form is complete and accurate. Incomplete or incorrect information might invalidate the document.
  4. Signature requirements: The Kansas DNR form requires signatures from the patient or their legally authorized representative and the physician. Ensure that both parties sign the document for it to be legally valid.
  5. Make it accessible: Once the DNR order is completed and signed, keep it in a place where it can be easily found by family members and healthcare providers.
  6. Living will and medical power of attorney: Consider complementing your DNR with a living will and medical power of attorney, which provide comprehensive guidance on your healthcare preferences beyond the scope of the DNR.
  7. Availability during emergencies: It's important to have your DNR order readily available in case of an emergency. Some people choose to carry a DNR bracelet or keep a card in their wallet.
  8. Communicate with your family: Discuss your decision to have a DNR order with close family members or friends to ensure they understand your wishes and the reasons behind your decision.
  9. Review and update regularly: Healthcare preferences can change over time. Review your DNR order periodically and update it if necessary. Always communicate any changes to your healthcare providers and family.
  10. Know the legal implications: Understanding the legal implications of a DNR in Kansas is crucial. It only applies to CPR and does not affect other treatments. Make sure your healthcare provider explains the scope of the DNR order.

Dealing with DNR orders can be challenging, but they are an important aspect of healthcare planning. Be proactive, seek advice, and make decisions that best reflect your healthcare wishes and values.

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