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Kansas Do Not Resuscitate Form 2

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Kansas Do Not Resuscitate Form 2 Page 2
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place to nd more information about a state’s
policies on advance directives such as the
DNR directive is the health department or
the state oce on aging. You can also ask a
physician, health care provider or nancial or
legal advisor for more information.
A DNR directive is a dated and witnessed
document that is put into writing. e
document must be signed by you and your
physician or for you by someone else based
upon your expressed direction. A signature
from a physician is not required if you are a
member of a church which provides medical
treatment by spiritual means, such as through
prayer alone and other care consistent with
your church or religion.
If someone else signs for you, they must do
so in your presence and at your direction.
e witness must be: 1) at least 18 years of
age, 2) not related to you by blood or marriage,
3) not entitled to your estate, 4) not nancially
responsible for your medical care, and 5) not
the same person who signed the document for
you at your direction if you are unable to sign
for yourself.
e DNR directive provides coverage for
you when living at home. For example, if you
are receiving hospice services or other end-
of-life care at home and do not want to be
resuscitated if your heart or breathing stops,
then you may nd this form helpful.
Your physician could also write a DNR
order as part of your medical record during
an admission to a hospital or care facility. A
durable power of attorney for health care may
ask for a DNR order on your behalf if those
were your wishes prior to the illness or injury.
A health care provider who in good faith
honors a DNR directive, order, or insignia
is not civilly liable, or guilty of a crime or of
unprofessional conduct.
After Completing a DNR Directive
Once you have completed a DNR directive,
it is especially important to inform your family
about your wishes. Give copies to your loved
ones, doctors, hospital, and lawyer, if you have
one. Keep a copy on hand. You may want to
consider carrying a copy with you, or placing
a note in your wallet or purse stating that you
have a DNR directive and where it can be
found. ere are some private companies that
can electronically store your advance directives
via the Internet. Others provide bracelets
to wear that indicate your wishes. ere are
typically fees for these services. You may
want to consider placing copies of your DNR
directive in your automobile’s glove box.
Taking these steps might eliminate possible
confusion in case of an emergency. Although
medical professionals do want to honor your
end-of-life decisions, they are likely to err
on the side of caution if your wishes about
resuscitation are not clear. e DNR directive
or insignia must be given or shown to the
person responding to the emergency before
resuscitation is started. erefore, you want
to store the DNR directive someplace that
is easily accessible to your family members
or loved ones so that it may be given to the
emergency response team when they arrive or
to hospital personnel when you are admitted.
Summary
inking about what you desire at the end
of life is an important task. Communicate with
your family and health care providers. Keep
copies of your advance directives available in
case of emergency. If you would like more
information about this subject, please see
additional K-State Research and Extension
publications on advance directives, durable
power of attorney for health care, and living
wills. Also see the list of Kansas Resources for
more information.
Kansas Do Not Resuscitate Form 2