Printable Do Not Resuscitate Form Michigan PRINT Witness s name Date mm dd yyyy Witness signature PRINT Witness s name Date mm dd yyyy THIS FORM WAS PREPARED PURSUANT TO AND IN COMPLIANCE WITH THE MICHIGAN DO NOT RESUSCITATE DECLARATION PROCEDURE ACT 1996 PA 193 PROVIDERS PLEASE RETAIN A COPY OF ALL PAGES FOR THE
Who May Complete A Do Not Resuscitate Form A competent adult who has discussed the issue with his or her physician The physician must also sign the order People whose religion opposes medical treatment don t need a doctor s signature THIS FORM WAS PREPARED PURSUANT TO AND IN COMPLIANCE WITH THE MICHIGAN DO NOT RESUSCITATE PROCEDURE ACT Made Fillable by eForms DO NOT RESUSCITATE ORDER request that in the event my heart and breathing should stop no person shall attempt to resuscitate me
Printable Do Not Resuscitate Form Michigan
Printable Do Not Resuscitate Form Michigan
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D Do Not Resuscitate Declaration What is a do not resuscitate declaration A do not resuscitate declaration DNR declaration is a written document in which you express your wish that if your breathing and heartbeat cease you do not want anyone to attempt to resuscitate you For whom might such a document be particularly useful THIS FORM WAS PREPARED PURSUANT TO AND IN COMPLIANCE WITH THE MICHIGAN DO NOT RESUSCITATE PROCEDURE ACT DO NOT RESUSCITATE ORDER request that in the event my heart and breathing should stop no person shall attempt to resuscitate me This order is effective until it is revoked by me
Patient is wearing a do not resuscitate identification bracelet which is clearly imprinted wit the words Do Not Resuscitate Order name and address of declarant and the name and telephone number of declarant s attending physician if any OR This form is usually filled out by people with some severe health conditions in which there would not be any use gained from a CPR procedure In other cases when the person is perfectly fine or does not have any
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Under Michigan law a do not resuscitate order is a voluntarily signed form by either a person a patient advocate or a guardian The order states that if the person s heart or breathing stops there should be no resuscitation efforts made Resuscitation efforts include mouth to mouth resuscitation cardiopulmonary resuscitation CPR and INSTRUCTIONS consists of 3 parts consent physician signature and witnessing Make a copy of the Michigan Do Not Resuscitate form If you do not have a copy it can be found at https www michigan gov documents mdch DNR update March 14 final release 453815 7 pdf
If a do not resuscitate order form is presented and is not substantially in the form Type or print witness s name THIS FORM WAS PREPARED PURSUANT TO AND IS IN COMPLIANCE WITH THE MICHIGAN DO NOT RESUSCITATE ACT ANNEX 1 Michigan General Procedures DO NOT RESUSCITATE Date revised March 25 A do not resuscitate DNR order is used for patients who do not want to be saved if their heart or breathing stops This is generally the case for individuals with late stages of cancer or other advanced medical issues
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Printable Do Not Resuscitate Form Michigan - Michigan Do Not Resuscitate Form Use a michigan dnr form 2022 template to make your document workflow more streamlined Show details We are not affiliated with any brand or entity on this form How it works Upload the state of michigan do not resuscitate form Edit sign michigan do not resuscitate form pdf from anywhere