Maryland EMS Do Not Resuscitate Order Form
This document outlines the Maryland Emergency Medical Services Do Not Resuscitate (DNR) order procedures. It provides essential information and instructions for healthcare providers. This form ensures patient preferences regarding resuscitation are respected during emergency situations.
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How do I fill this out?
Filling out this form requires careful attention to patient details and preferences. Ensure that the appropriate sections are completed accurately. Follow the provided instructions for signing and using the EMS/DNR bracelet.
How to fill out the Maryland EMS Do Not Resuscitate Order Form?
1
Complete the EMS/DNR form with patient information.
2
Mark the appropriate options based on the patient's wishes.
3
Have a physician or nurse practitioner sign the document.
4
If using a bracelet, complete the necessary section.
5
Keep a valid copy easily accessible for EMS personnel.
Who needs the Maryland EMS Do Not Resuscitate Order Form?
1
Patients with terminal illnesses who wish to avoid resuscitation.
2
Healthcare agents designated by patients to make medical decisions.
3
Legal guardians of minors who need to establish DNR orders.
4
Surrogates for patients unable to communicate their wishes.
5
Attending physicians who require clarity on DNR preferences.
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1
Open the PDF file on PrintFriendly.
2
Select the 'Edit' option to modify the document.
3
Make necessary changes, ensuring patient information is correct.
4
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What are the instructions for submitting this form?
To submit the EMS/DNR form, ensure it is completed and signed by the appropriate healthcare provider. You may submit the form in person to your healthcare facility or send it via fax to the designated number of your provider. For any inquiries, please use the provided contact methods to ensure your document is received and processed efficiently.
What are the important dates for this form in 2024 and 2025?
There are no expiration dates for EMS/DNR orders in Maryland. Patients and healthcare providers are encouraged to review these orders annually. Ensure your information remains current to reflect your wish for resuscitation appropriately.
What is the purpose of this form?
The purpose of this form is to establish a patient's wishes regarding resuscitation during medical emergencies. It serves as a legal directive to healthcare providers, ensuring that patients who do not wish to receive CPR are honored accordingly. This form fosters communication between patients and medical professionals about end-of-life care preferences.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Identifying Information: Contains the patient's name and date of birth for identification.
- 2. Physician's or Nurse Practitioner's Order: Details the type of care preferred by the patient under emergency circumstances.
- 3. Certification: Confirms the order is based on informed consent from the patient or their representative.
- 4. Signature: Requires the signing physician's or nurse practitioner's information.
- 5. Bracelet Information: Guides users on how to complete and use the optional EMS/DNR bracelet.
What happens if I fail to submit this form?
Failing to submit the EMS/DNR order can lead to emergency medical personnel performing resuscitation against the patient's wishes. It is critical to ensure that the form is completed and available to avoid unwanted interventions.
- Unwanted Resuscitation: Patients may experience procedures they do not wish to undergo.
- Legal Implications: Healthcare providers may face legal challenges if preferences are not documented.
- Emotional Distress: Families may endure stress during emergencies if patient wishes are ignored.
How do I know when to use this form?
- 1. Terminal Illness: Patients with terminal diagnoses may want to avoid aggressive resuscitation.
- 2. Patient's Wishes: Documenting a patient's specific resuscitation wishes ensures they are met.
- 3. Legal Documentation: Provides a legal framework for healthcare providers to follow.
Frequently Asked Questions
How do I fill out the EMS/DNR form?
Simply complete all required patient information and select your preferences.
Can I edit the EMS/DNR PDF?
Yes, you can easily edit the PDF using our PDF editor.
Is a physician's signature required?
Yes, the form must be signed by a licensed physician or nurse practitioner.
What if I change my mind about DNR status?
You can revoke the EMS/DNR order at any time by notifying emergency personnel.
Can I print the form after editing?
Yes, you can print the finalized version of the document.
Where should I keep the EMS/DNR order?
It should be kept in a safe but easily accessible location.
Can I use this form for minors?
Yes, the form can be used for minors by involving their guardians.
Are copies of the EMS/DNR order valid?
Yes, copies are valid and can be used by emergency services.
What if I need further assistance with the form?
You can contact the MIEMSS EMS/DNR Program office for help.
How do I ensure my wishes are respected?
Clearly fill out and share the EMS/DNR order with healthcare providers.
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