Oregon Do Not Resuscitate Order
This Do Not Resuscitate (DNR) Order is a legal form, governed by Oregon state laws regarding advance directives. This document grants specific instructions regarding resuscitation measures in the event of cardiac or respiratory arrest.
It is crucial to fill out the following sections accurately to ensure your healthcare wishes are respected.
Patient Information:
- Patient's Name: _______________
- Date of Birth: _______________
- Patient's Address: _______________
- Patient's Phone Number: _______________
Health Care Representative (if applicable):
- Name: _______________
- Phone Number: _______________
Order Statement:
I, the undersigned, am requesting that in the event of a cardiac or respiratory arrest, no resuscitative measures be initiated. This decision has been made freely and without coercion. I understand the implications of this directive.
Signature: _______________
Date: _______________
Witness Information:
- Witness Name: _______________
- Date: _______________
Please keep a copy of this document in a safe place and consider providing copies to your healthcare provider, family members, and anyone else who may need to be aware of your wishes.