Official  Do Not Resuscitate Order Document for Maine Open Do Not Resuscitate Order Editor Now

Official Do Not Resuscitate Order Document for Maine

A Maine 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 is crucial for ensuring that healthcare providers respect a person's preferences about life-saving measures. Understanding the implications of a DNR order can empower individuals to make informed decisions about their healthcare.

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Table of Contents

In Maine, the Do Not Resuscitate (DNR) Order form serves as a critical document for individuals who wish to express their preferences regarding medical treatment in emergency situations. This form allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) if their heart stops beating or if they stop breathing. It is designed to ensure that healthcare providers respect the wishes of patients, particularly those with terminal illnesses or severe medical conditions. The DNR Order must be signed by a licensed physician, and it is important for individuals to discuss their decision with family members and healthcare professionals to ensure everyone understands the implications. Additionally, the form must be readily accessible in case of an emergency, and it can be placed in a visible location, such as on the refrigerator or with other important medical documents. Understanding the DNR Order form is essential for anyone considering this option, as it empowers individuals to make informed choices about their end-of-life care.

Form Sample

This Maine Do Not Resuscitate Order (DNR) template is created in accordance with the relevant state-specific legislation, including but not limited to the Maine Health Care Advance Directive Act. It is designed to inform medical professionals of an individual’s decision not to receive cardiopulmonary resuscitation (CPR) in the event that their breathing stops or their heart stops beating.

To complete this document, please provide the following information:

  • Full Name of the Individual (Patient): _________________
  • Date of Birth: _________________
  • Maine Identification Number (if applicable): _________________
  • Address: _________________
  • Telephone Number: _________________

Emergency Medical Personnel are instructed not to initiate CPR if they find this document presented in conjunction with a valid identification belonging to the aforementioned individual.

The decision for a DNR must be made by the individual or their legally authorized representative. This document should be signed by one of the following:

  1. The Individual (Patient) making the DNR request.
  2. The legally authorized representative, in cases where the individual is unable to make such decisions.
  3. The attending physician, after consultation with the individual or their legally authorized representative.

Signatures:

Individual/Patient: __________________________ Date: _________________

Legally Authorized Representative: __________________________ Date: _________________

Attending Physician: __________________________ Date: _________________ License Number: _________________

This order is valid throughout Maine unless revoked. The individual retains the right to revoke this order at any time. The revocation must be communicated verbally or in writing to the attending physician or medical personnel. Should the individual decide to revoke this DNR order, a new document must be completed and signed.

By completing this Maine Do Not Resuscitate Order, the individual acknowledges their understanding and consent to the terms outlined within. It is recommended that this document be reviewed by legal counsel to ensure comprehensiveness and compliance with Maine law.

PDF Form Details

Fact Name Description
Definition A Maine Do Not Resuscitate (DNR) Order is a legal document that allows individuals to refuse resuscitation efforts in the event of cardiac arrest or respiratory failure.
Governing Law The Maine DNR Order is governed by Title 22, Chapter 205 of the Maine Revised Statutes.
Eligibility Any adult can complete a DNR order. This includes individuals with terminal illnesses or those who wish to avoid aggressive medical interventions.
Signature Requirement The DNR order must be signed by the patient or their legal representative, and it must also be signed by a physician.
Form Availability The DNR order form is available through healthcare providers, hospitals, and online resources provided by the state.
Revocation A DNR order can be revoked at any time by the patient or their representative, either verbally or in writing.
Emergency Services Emergency medical personnel are required to honor a valid DNR order when they encounter it in the field.
Notification It is recommended that individuals keep a copy of their DNR order in a visible place, such as on their refrigerator or with their medical records.
Limitations The DNR order specifically addresses resuscitation efforts and does not affect other medical treatments or care decisions.
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