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Click ‘Get Form’ to open the Do Not Intubate Form in the editor.
Begin by entering your name in the designated field at the top of the form, ensuring it matches your identification documents.
In the section regarding your medical illness, provide a brief description of your diagnosis as discussed with your physician.
Select the checkbox for 'DO NOT INTUBATE' to indicate your wishes regarding mechanical ventilation. Make sure you understand this means no tube will be placed in your airway.
If applicable, check 'DO NOT RESUSCITATE (DNR)' to specify that no artificial resuscitation should be initiated if your heart stops or breathing is inadequate.
Sign and date the form where indicated, ensuring that either you or your Durable Power of Attorney for Health Care completes this step.
Fill in your address and ensure a witness signs the document as required.
Finally, have your physician complete their section, including their signature and date, confirming they have discussed this order with you.
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Strictly defined, a do not resuscitate/do not intubate (DNR/DNI) status indicates a patient does not want to receive CPR or intubation in the event of cardiopulmonary arrest.
Does DNR include do not intubate?
In medical terms, a DNI means that patients do not want a breathing tube inserted into their trachea, via the nose or mouth, to restore normal breathing. If the patients breathing remains impaired, the tube remains in place and is eventually connected to a ventilator to maintain breathing.
How do you get a do not intubate order?
How is a DNR Order Created? If you decide you want a DNR order, tell your provider and health care team what you want. Your provider must follow your wishes, or: Your provider may transfer your care to a provider who will carry out your wishes.
nebraska do not resuscitate form
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Section 6 be read prior to Sections 25. Section 1 is the standard introduction to an IRIS Toxicological Review, describing the purpose of the assessment and
Incomplete forms may be returned as being invalid. □DO NOT INTUBATE I understand that DO NOT INTUBATE means that in the event that my breathing is inadequate.
It is the responsibility of the licensed practitioner to be informed in all aspects of patient care and determine the best treatment for each individual patient
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