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Iowa Do Not Resuscitate Form

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Iowa Do Not Resuscitate Form Page 2
Iowa Do Not Resuscitate Form
Directionsforobtainingauniformidentier:
The uniform identier may be obtained through MedicAlert®
1
, which requires:
1. A
completedMedicAlert®application, which is available in physician ofces or through
MedicAlert® by phoning (800)432-5378 or the Web site w
ww.medicalert.org, andfee.
2. A copyofthiscompletedOOHDNRorder, which must accompany the MedicAlert®
application or be sent to MedicAlert® prior to the identiers being mailed.
1
MedicAlert® is a nonprot 501C membership organization.
S
uggestedguidelinesforphysicians:
1. Please review the Iowa Out-of-Hospital Do-Not-Resuscitate order and related protocol with the
patient/patient’s legal representative(s). The following points may be helpful:
Patient/patient’s legal representative(s) listed on this order must understand the signicance of
this order, that in the event the patient’s heart or breathing stops or malfunctions, the anticipated result
of this order is death.
Patient/patient’s legal representative(s) listed on this order may revoke this directive at any time.
However, the desire to revoke must be communicated to the EMS or other health care professionals at
the scene.
It is important to emphasize that this order does not apply to medical interventions to make the
patient more comfortable.
The importance of wearing the uniform identier for those qualied patients who would benet
from the mobility this offers should be stressed. It is also helpful to walk patients through the process
they must follow to acquire the identier.
2. Provide a copy of this order to the patient/patient’s legal representative(s) listed on this order
and place the original in the patient’s medical records.
The OOH DNR Order form is available through the Iowa Department of Public Health, Bureau of
EMS, Lucas State Ofce Building, Des Moines, Iowa 50319-0075, or through the Bureau of EMS’s
Web site w
ww.idph.state.ia.us/ems.
Iowa Do Not Resuscitate Form
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