Attorney-Approved Hawaii Do Not Resuscitate Order Form

Guide to Writing Hawaii Do Not Resuscitate Order

A Do Not Resuscitate (DNR) Order form is a critical document for those in Hawaii who wish to express their desire not to have cardiopulmonary resuscitation (CPR) performed on them in case their breathing stops or their heart stops beating. This form must be filled out correctly to ensure that healthcare providers are aware of and respect the individual's wishes. The following steps are designed to guide you through the process of completing the Hawaii Do Not Resuscitate Order form accurately.

1. Begin by entering the patient's full legal name at the top of the form to establish whose medical decisions the DNR order is concerning.
2. Next, include the patient's date of birth to provide necessary identification information that matches medical records.
3. Fill in the patient's address, including street name and number, city, state, and zip code to ensure the DNR order can be accurately linked to the patient’s residence and medical records.
4. Provide the patient's Medical Record Number (MRN), if known, to further assist in matching the DNR order with the patient's medical history.
5. If the patient has an identifier such as a social security number (SSN) or state-issued identification number, include this information for additional identification verification.
6. Specify the name, address, and contact information of the patient's primary physician. This ensures the doctor is aware of the DNR order and can provide relevant medical advice or intervention according to the patient's wishes.
7. The form must be signed by the patient, indicating their understanding and agreement to the DNR order. If the patient is unable to sign due to physical or mental incapacity, a legally authorized representative may sign on their behalf. Include the date of signing beside the signature.
8. Lastly, the form requires a physician's signature to validate the DNR order. The physician must complete their section, including their name, address, phone number, and the date they reviewed and agreed to the DNR order. This final step confirms the medical validity and enforceability of the document.

Once the form is fully completed and signed by all necessary parties, it should be kept in a location where it can be easily accessed by family members or healthcare providers in case of an emergency. Additionally, consider informing close family members, caregivers, and possibly local medical facilities of the existence and location of this document to further ensure the patient's wishes are respected.

1. What is a Do Not Resuscitate (DNR) Order in Hawaii?

   A Do Not Resuscitate (DNR) Order in Hawaii is a legal document that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a person's breathing stops or if the heart stops beating. It is intended for use by individuals who wish to avoid CPR in the event of a life-threatening situation, based on personal, medical, or ethical reasons. This order must be signed by both the patient and the physician to be valid.

2. Who can establish a DNR Order in Hawaii?

   Adults who can make their own healthcare decisions, a legal guardian, or a healthcare power of attorney can establish a DNR Order in Hawaii. It is critical that the person understand the implications of the DNR Order, including that CPR will not be attempted in case of cardiac or respiratory arrest.

3. How can one obtain a DNR Order form in Hawaii?

   Hawaii's DNR Order forms can be obtained through healthcare providers, including physicians, hospitals, and nursing homes. Additionally, the Department of Health in Hawaii provides resources and can offer guidance on how to obtain and fill out the necessary paperwork.

4. What information is needed for a DNR Order in Hawaii?

   To complete a DNR Order in Hawaii, the following information is needed: the patient's full name, date of birth, and specific directives about not receiving CPR. The document must also be signed and dated by the physician and the patient or their legally authorized representative.

5. Is a Hawaii DNR Order valid in other states?

   DNR Orders are state-specific. While many states have reciprocity agreements or may honor a DNR Order from another state as a courtesy, it is not guaranteed. If you travel or move, it's advisable to check the local laws and, if necessary, obtain a new DNR Order that complies with those laws.

6. Can a DNR Order be revoked or changed?

   Yes, a DNR Order in Hawaii can be revoked or changed at any time by the person who established it, provided they have the capacity to make healthcare decisions. To revoke or amend a DSNR, notify your healthcare provider of your desire to change your decision, and follow any required procedures to make the change official, such as completing new documentation.

7. What should be done with the DNR Order once it is completed?

   Once a DNR Order is completed, it should be placed in a location where it is easily accessible to emergency responders, such as with the person’s medical records or in a visible area within the home. Copies should be provided to the person’s physician, close family members, or a healthcare power of attorney, and it may also be advisable to carry a copy when outside the home.

1. One common mistake is incomplete information. People often leave out critical details required on the Do Not Resuscitate (DNR) order form. This can include personal information, medical history, or specifics regarding their wishes for end-of-life care. Every section of the form plays a crucial role in ensuring that the individual's preferences are fully understood and respected.

2. Another mistake is failure to obtain the required signatures. For a DNR order to be legally effective in Hawaii, it must be signed by both the individual (or their legal representative) and a physician. These signatures affirm that there has been a discussion about the DNR order's implications and that there is mutual agreement on the decision not to pursue resuscitation in the event of cardiac or respiratory arrest.

3. A further error involves misunderstanding the form's limits. Some individuals mistakenly believe that a DNR order covers a broader range of medical interventions than it actually does. The form specifically relates to cardiopulmonary resuscitation (CPR) in the event the person's breathing or heartbeat stops. It does not cover other medical treatments or decisions about end-of-life care.

4. Last but certainly not least, there is the error of improper or inadequate communication about the DNR order. After completion, it is essential to communicate the existence of this order to all relevant parties, including family members, caregivers, and healthcare providers. Failure to do so can lead to confusion and emotional distress for loved ones, and potentially result in the individual's wishes not being honored due to unawareness of the DNR order.

In the context of end-of-life care planning, documents play a crucial role in ensuring individuals' health care preferences are respected and followed. Alongside the Hawaii Do Not Resuscitate (DNR) Order form, several other essential forms and documents often come into use to create a comprehensive care plan. These documents, each serving a unique purpose, help individuals communicate their medical treatment preferences, nominate health care decision-makers, and outline care preferences in various conditions. Understanding each document’s role can significantly enhance the effectiveness of health care planning.

• Advance Health Care Directive: This document allows individuals to outline their medical treatment preferences and appoint a health care power of attorney. The person chosen will have the authority to make health care decisions on the individual’s behalf if they become incapable of doing so.
• Medical Power of Attorney (POA): Specifically designates a person to make health care decisions when the individual is unable to communicate their wishes. It's crucial in situations that do not fall under the conditions specified in the DNR.
• Living Will: Unlike the Advance Health Care Directive, a living will provides detailed instructions about the types of life-sustaining treatments an individual does or does not want, like mechanical ventilation or feeding tubes, in case of a terminal illness or persistent vegetative state.
• POLST (Physician Orders for Life-Sustaining Treatment): A form that translates an individual's preferences into medical orders. It is used for seriously ill or frail patients for whom their physicians believe a DNR order and other specific instructions about end-of-life care are appropriate.
• Organ and Tissue Donation Form: Allows individuals to specify their wishes regarding organ and tissue donation after death. This can be a separate document or part of an advance directive, depending on state laws.
• Portable Medical Order: Similar to a POLST, this document includes specific instructions about treatments the patient does or does not want to be applied across different settings, not just in a hospital.
• Guardianship Appointment: In situations where individuals have not appointed a medical POA and are unable to make decisions for themselves, a guardianship appointment is a court-ordered arrangement assigning someone the responsibility to make personal, medical, and sometimes financial decisions on the individual’s behalf.

These documents, when prepared thoughtfully and in consultation with healthcare providers and legal advisors, ensure that healthcare treatments align with the individual's wishes. They are particularly important in emergencies or when the individual cannot communicate their preferences. In Hawaii, incorporating these forms alongside the Do Not Resuscitate Order can provide a more comprehensive approach to end-of-life care planning, ensuring dignity, respect, and personalized care at life’s end.

The Hawaii Do Not Resuscitate Order form is similar to several other legal documents that are used to manage healthcare decisions and end-of-life care. These documents, including Advance Healthcare Directives, POLST forms, and Living Wills, each play a distinctive role in planning for medical care. Though they vary in function, they are all connected by the underlying purpose of respecting the wishes of individuals regarding their treatment preferences. Understanding how each of these documents relates to a Do Not Resuscitate (DNR) Order can provide clarity and direction when making healthcare decisions.

Advance Healthcare Directive: The Hawaii Do Not Resuscitate Order form is similar to an Advance Healthcare Directive in that both allow individuals to outline their healthcare preferences in advance. However, while a DNR specifically instructs healthcare providers not to perform CPR in the event of cardiac or respiratory arrest, an Advance Healthcare Directive covers a broader range of medical treatments and interventions. It can include instructions on the use of ventilators, feeding tubes, and other life-sustaining measures, as well as appoint a healthcare proxy to make decisions on behalf of the individual if they are unable to do so themselves.

Physician Orders for Life-Sustaining Treatment (POLST) Form: Another document similar to the Hawaii DNR Order is the POLST form, which stands for Physician Orders for Life-Sustaining Treatment. Like a DNR, a POLST form provides specific instructions regarding emergency medical care, including the use or refusal of CPR. However, the POLST form goes further by addressing other critical interventions, such as antibiotic use, intubation, and mechanical ventilation, based on the individual's current health condition. It is designed for seriously ill or frail individuals for whom healthcare professionals believe CPR would be medically ineffective or for those who want to specify their preferences for end-of-life care.

Living Will: A Living Will bears similarity to a Hawaii Do Not Resuscitate Order form in its focus on end-of-life care decisions. Both documents enable individuals to declare their wishes regarding life-sustaining treatments if they are terminally ill or in a persistent vegetative state. Nevertheless, a Living Will is more comprehensive, allowing individuals to express whether they would like treatments that could extend life, such as the use of respirators, artificial nutrition, and hydration, under specific circumstances. Unlike a DNR order, which is applicable primarily in cases of cardiac or respiratory failure, a Living Will provides a broader scope of directives for various medical situations.

When filling out the Hawaii Do Not Resuscitate (DNR) Order form, it is crucial to handle the document with care to ensure it accurately reflects the patient's wishes regarding resuscitation efforts. Below is a list of things you should and shouldn't do:

Things You Should Do:

1. Read the form thoroughly to understand the scope and implications of the DNR Order.

2. Discuss the decision with the patient (if possible) and their family members to ensure it reflects the patient's wishes.

3. Ensure the patient or their legally authorized representative signs and dates the form, as required by Hawaii law.

4. Consult with a medical professional or a legal advisor if you have any questions or concerns about how to properly complete the form.

5. Make multiple copies of the completed form. Keep the original with the patient’s medical records and provide copies to relevant healthcare providers and family members.

6. Review and update the form as necessary, especially if the patient’s medical condition or preferences change.

Things You Shouldn't Do:

• Do not fill out the form without the explicit consent of the patient or their legally authorized representative.

• Do not leave any sections of the form blank. Incomplete forms may not be legally valid.

• Do not use ambiguous language. Be clear and specific in your responses to avoid any misinterpretation.

• Do not forget to review and confirm that all the information provided is accurate and up to date.

• Do not fail to communicate the existence of the DNR Order to all healthcare providers involved in the patient’s care.

• Do not ignore state-specific requirements or procedures for filing and maintaining the DNR Order.

Many people have misunderstandings about the Hawaii Do Not Resuscitate (DNR) Order form, which can lead to confusion and distress. Here's a list of common misconceptions clarified to help better understand what a DNR form entails in Hawaii:

• It's only for the elderly: DNR orders are not exclusive to the elderly. They are available to anyone with a serious health condition who wishes not to receive cardiopulmonary resuscitation (CPR) in the event their breathing stops or their heart stops beating.
• A doctor can issue it without consent: A DNR order must involve discussions between the patient and their healthcare provider, and it requires the patient's or their legal representative's consent. It cannot be issued without the patient's approval.
• It applies to all medical treatments: A DNR order specifically refers to not applying CPR, not other treatments. Patients with a DNR can still receive medications, oxygen, and other forms of care to provide comfort and manage symptoms.
• It's permanent and irreversible: A DNR order can be revoked or altered at any time by the patient or their legal representative if the patient is unable to communicate their wishes.
• It's only effective in a hospital: In Hawaii, DNR orders are also effective outside of hospitals, such as in homes or in public places, provided they are presented to and recognized by the responding healthcare professionals or emergency personnel.
• Only a doctor can create it: While a doctor's signature is required, the process involves a discussion with the patient (when possible) and/or the patient's healthcare proxy or legal representative to ensure it reflects the patient's wishes.
• It guarantees no attempts at resuscitation: While a DNR aims to prevent CPR, in chaotic emergency situations, there may be confusion or a delay in finding the DNR order. It's important to ensure that the document is easily accessible and communicated to all healthcare providers.
• A lawyer is needed to complete the form: While legal advice can be helpful in understanding the implications of a DNR, a lawyer is not required to fill out the DNR form. The process mainly involves healthcare providers and the patient or their representative.
• It's the same as a Living Will: A DNR is specifically about CPR and does not cover other treatments or decisions in the event of incapacity. A Living Will is broader and can include directives about different kinds of life-sustaining treatments.
• It means "Do Not Treat": A common misunderstanding is that a DNR means the patient will not receive any medical intervention. In truth, it only applies to the withholding of CPR. Other treatments to relieve pain and discomfort are not only allowed but encouraged.

• A Hawaii Do Not Resuscitate (DNR) Order form is used to inform medical personnel not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient’s heart stops beating. It is a critical document for those who wish to decline life-extending treatments under certain circumstances.

• The form must be completed and signed by both the patient or their legally authorized representative and the patient's physician. This signature requirement ensures that the decision is made collaboratively and with full understanding of its implications.

• It is important to clearly communicate the existence of a DNR Order to family members and healthcare providers. Keeping multiple copies in easily accessible locations, such as in your personal medical records and with close family members, helps ensure that your wishes are followed.

• In addition to the DNR Order, it is advisable to have other advance directives in place, such as a living will or healthcare power of attorney. These documents provide a broader scope of instructions regarding your healthcare preferences beyond the specific scope of a DNR.

• The effectiveness of a DNR Order is immediate upon completion and remains in effect until it is formally revoked. A patient or their authorized representative can revoke the DNR Order at any time, but it is essential to communicate this change to all relevant parties, particularly healthcare providers.