Pennsylvania Do Not Resuscitate Order Guidance
This document provides essential information regarding the Out-of-Hospital Do-Not-Resuscitate (DNR) Order in Pennsylvania. It outlines the necessary steps for physicians and patients regarding do-not-resuscitate treatment. Users can understand the legal requirements and procedures for obtaining and executing a DNR order effectively.
Edit, Download, and Sign the Pennsylvania Do Not Resuscitate Order Guidance
Form
eSign
Add Annotation
Share Form
How do I fill this out?
To fill out the Out-of-Hospital Do-Not-Resuscitate Order, begin by filling in the patient's name and the attending physician's information. Ensure the selection criteria are met, including conditions like being terminally ill. Finally, sign the form along with any necessary witnesses or surrogates as required by law.

How to fill out the Pennsylvania Do Not Resuscitate Order Guidance?
1
Fill in the patient's name and attending physician information.
2
Confirm eligibility criteria for issuing the DNR order.
3
Ensure signatures from all required parties.
4
Review the completed form for accuracy before submission.
5
Store or display the DNR order as required by law.
Who needs the Pennsylvania Do Not Resuscitate Order Guidance?
1
Terminally ill patients who wish to refuse resuscitation efforts.
2
Patients with end-stage medical conditions to maintain comfort.
3
Individuals with a living will directing their medical care preferences.
4
Surrogates of patients who are unable to make medical decisions.
5
Healthcare providers needing a legal directive for patient care decisions.
How PrintFriendly Works
At PrintFriendly.com, you can edit, sign, share, and download the Pennsylvania Do Not Resuscitate Order Guidance along with hundreds of thousands of other documents. Our platform helps you seamlessly edit PDFs and other documents online. You can edit our large library of pre-existing files and upload your own documents. Managing PDFs has never been easier.

Edit your Pennsylvania Do Not Resuscitate Order Guidance online.
Editing the Out-of-Hospital Do-Not-Resuscitate Order on PrintFriendly is user-friendly and straightforward. You can enter necessary information directly into the PDF fields and make any adjustments easily. Use our intuitive interface to ensure that your document reflects current medical instructions accurately.

Add your legally-binding signature.
With PrintFriendly, signing your PDF is a seamless process. You can directly add your signature in the designated area of the form. Once signed, your DNR order is ready for use and can be printed as needed.

Share your form instantly.
Sharing your completed PDF is simple with PrintFriendly. Once your DNR order is ready, you can easily send it to your healthcare providers or family members via email. Make sure your loved ones are informed about your medical care preferences by sharing the document promptly.
How do I edit the Pennsylvania Do Not Resuscitate Order Guidance online?
Editing the Out-of-Hospital Do-Not-Resuscitate Order on PrintFriendly is user-friendly and straightforward. You can enter necessary information directly into the PDF fields and make any adjustments easily. Use our intuitive interface to ensure that your document reflects current medical instructions accurately.
1
Open the PDF document in PrintFriendly.
2
Click on any field to enter or modify the information.
3
Review each section to ensure accuracy.
4
Save the changes and your edited document.
5
Print or share your finalized DNR order as needed.

What are the instructions for submitting this form?
To submit the Out-of-Hospital DNR Order, provide a completed copy to your healthcare provider, ensuring they have immediate access to it. You may also want to keep a copy in a clearly accessible location within your house. If applicable, provide copies to family members and any relevant healthcare facilities.
What are the important dates for this form in 2024 and 2025?
The Out-of-Hospital Do-Not-Resuscitate Order is effective from January 28, 2007. Patients should be informed that the order remains valid until revoked or upon the patient's death. Always check for any pertinent updates to regulations surrounding the DNR orders in Pennsylvania.

What is the purpose of this form?
The Out-of-Hospital Do-Not-Resuscitate Order serves as a legal document that allows patients to refuse resuscitation efforts under specific conditions. It is designed to ensure that healthcare providers respect the wishes of patients regarding their end-of-life care. This form is an essential tool for enabling patients and their surrogates to make informed decisions about life-sustaining treatment.

Tell me about this form and its components and fields line-by-line.

- 1. Patient's Name: The full name of the patient requesting the DNR order.
- 2. Attending Physician Statement: The physician's confirmation of the patient's eligibility for DNR.
- 3. Patient's Statement: The patient's own decision regarding resuscitation efforts.
- 4. Surrogate's Statement: Certification from the surrogate of their authority to execute the order.
- 5. Signatures: Required signatures from the physician, patient, and surrogate if applicable.
What happens if I fail to submit this form?
Failing to submit the Out-of-Hospital DNR Order may lead to unwanted resuscitation efforts during a medical emergency. This could cause unnecessary distress for the patient and their family members. Therefore, it is crucial to ensure that the DNR order is filled out and accessible.
- Unwanted Resuscitation: Patients may undergo life-saving procedures against their wishes.
- Legal Complications: Without a signed DNR order, healthcare providers may face legal dilemmas.
- Emotional Stress: Family members may experience trauma if their loved ones are resuscitated against their discussed wishes.
How do I know when to use this form?

- 1. End-of-Life Care Planning: To make clear medical care decisions in advance.
- 2. Healthcare Directives: To guide healthcare providers about the patient's wishes.
- 3. Surrogate Decision Making: To empower legally designated individuals to act on behalf of the patient.
Frequently Asked Questions
What is the purpose of the Out-of-Hospital DNR Order?
The DNR order allows patients to refuse resuscitation efforts in case of a cardiac or respiratory arrest.
Who can issue the Out-of-Hospital DNR Order?
Only an attending physician can issue and sign the DNR order for the patient.
How do I submit this form once completed?
You can provide the completed DNR order to your healthcare provider and ensure it is accessible.
Can a patient revoke the DNR order?
Yes, a patient has the right to revoke the DNR order at any time as long as they communicate their wish.
What should I include in the DNR order?
Make sure to fill in patient details, physician confirmation, and all required signatures.
Is the DNR order valid in all healthcare settings?
The DNR order is valid in out-of-hospital settings and must be honored by EMS providers.
What happens if the DNR order is not signed?
Without a signature from the attending physician, the DNR order is not valid.
Do I need a witness to sign the DNR order?
Witness requirements may vary by jurisdiction; check local laws for specific details.
Can family members review the DNR order?
Yes, family members should be informed of the DNR order for compliance with the patient's wishes.
What is included in the DNR order regarding pregnant patients?
Specific criteria must be met if the patient is pregnant, ensuring the safety of both mother and unborn child.
Related Documents - PA DNR Order Form

Preparticipation Physical Evaluation Form
The Preparticipation Physical Evaluation Form is used to assess the physical health and fitness of individuals before they participate in sports activities. It covers medical history, heart health, bone and joint health, and other relevant medical questions.

Health Insurance Tax Credits Guide 2015
This document provides a comprehensive guide on health insurance and premium tax credits for the 2015 tax year. It explains the tax filing rules, eligibility criteria, and detailed instructions for claiming and reporting premium tax credits. Essential for individuals who bought health insurance through the ACA Marketplaces.

TSP-77 Partial Withdrawal Request for Separated Employees
The TSP-77 form is used by separated employees to request a partial withdrawal from their Thrift Savings Plan account. It includes instructions for completing the form, certification, and notarization requirements. The form must be filled out completely and submitted along with necessary supporting documents.

Ray's Food Place Donation Request Form Details
This file contains the donation request form for Ray's Food Place. Complete the general information section and follow the guidelines to submit your donation request at least 30 days in advance. The form includes fields for organization details and donation specifics.

Pastoral Ministry Evaluation Form for Board of Elders
This evaluation form is designed for the Board of Elders to assess and provide feedback on a pastor's ministry. It aims to offer affirmation and identify areas for improvement. The form covers preaching, worship leading, pastoral care, administration, and more.

Health Provider Screening Form for PEEHIP Healthcare
This file contains the Health Provider Screening Form for PEEHIP public education employees and spouses. It includes instructions on how to fill out the form for wellness program participation. The form collects personal, medical, and screening details to assess wellness.

Common Law Marriage Declaration Form for FEHB Program
This form is used to declare a common law marriage for the purpose of enrolling a spouse under the Federal Employees Health Benefits (FEHB) Program. It requires personal details, marriage information, and additional documentation. Submission instructions and legal implications are included.

MyPRALUENT™ Enrollment Form Instructions and Details
This document provides comprehensive instructions and details for enrolling in the MyPRALUENT™ program, including benefits, patient assistance, and clinical support. It outlines the required patient, insurance, and prescriber information, as well as the steps for treatment verification and household income documentation.

Application for Certified Copy of Birth Certificate
This form is used to request a certified copy of a birth certificate from the Clerk of Court Office. It includes details about the applicant, the person named on the certificate, and requires a photo ID and the correct fee. This form is only for walk-in services.

Torrance Memorial Physician Network Forms for Patients 18+
This file contains important forms for patients 18 years and older registered with Torrance Memorial Physician Network. It includes patient registration, acknowledgment of receipt of privacy practices, and financial & assignment of benefits policy forms. Complete these forms to ensure your medical records are up-to-date and to understand your financial responsibilities.

Vodafone Phone Unlocking Guide: Steps to Unlock Your Phone
This guide from Vodafone provides a step-by-step process to unlock your phone. Learn how to obtain your unlock code by filling out an online form. Follow the instructions to complete the unlocking process.

Texas Automobile Club Agent Application Form
This file is the Texas Automobile Club Agent Application or Renewal form, which must be submitted within 30 days after hiring an agent. The form includes fields for agent identification, moral character information, and requires signature from both the agent and an authorized representative of the automobile club. Filing fees and submission instructions are also provided.