Idaho Do Not Resuscitate Order (DNRO) Template
This Do Not Resuscitate Order (DNRO) is a legal document that expresses your wishes regarding medical treatment in the event of a life-threatening situation. In Idaho, this document is recognized under the Idaho Code Section 39-450. It is essential to complete it accurately to ensure it reflects your desires.
Please fill in the blanks as indicated below:
Patient Information:
- Patient's Full Name: _______________
- Date of Birth: _______________
- Address: _______________
Health Care Decision-Maker (if applicable):
- Name: _______________
- Relationship to Patient: _______________
- Contact Number: _______________
Patient's Directive:
I, the undersigned, wish for my medical providers and emergency personnel to honor this Do Not Resuscitate Order. In the event of cardiac arrest or other life-threatening emergencies, I do not wish to receive cardiopulmonary resuscitation (CPR) or other aggressive life-saving measures.
Conditions Under Which This Order Applies:
This DNRO is applicable when I am in a state that prevents me from expressing my wishes, specifically:
- Cardiac arrest.
- Respiratory failure.
- Other critical medical conditions as determined by my physician.
Patient's Signature: _________________________ Date: ____________
Witness Signature: _________________________ Date: ____________
It is recommended to keep several copies of this DNRO. Provide copies to your healthcare provider, family members, and any appointed health care decision-makers.
Important Note: This document does not take effect until it is properly signed and dated by both the patient and a witness. Be sure to consult a healthcare professional for any guidance regarding this order.