Delaware Do Not Resuscitate Order
This Do Not Resuscitate (DNR) Order is made in accordance with Delaware law, specifically Title 16, Chapter 2503 of the Delaware Code. This document expresses the wishes of the individual regarding resuscitation efforts in the event of a medical emergency.
Patient Information:
- Full Name: ______________________________
- Date of Birth: _________________________
- Address: ________________________________
- Phone Number: __________________________
Healthcare Provider Information:
- Full Name: ______________________________
- Facility Name: __________________________
- Address: ________________________________
- Phone Number: __________________________
Order Statement:
I, the undersigned, hereby declare that I do not wish to receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures in the event of cardiac or respiratory arrest.
Signature: ________________________________
Date: ________________________________
This order should be honored by all healthcare providers and emergency personnel. It is advisable to keep a copy of this document in a visible location and share it with family members and caregivers.
Witness Information:
- Witness Name: __________________________
- Signature: _____________________________
- Date: ________________________________
By signing this document, I affirm that I am of sound mind and that I understand the implications of this Do Not Resuscitate Order.