Illinois DNR/POLST Form for Life-Sustaining Treatment
This file provides the Illinois Do Not Resuscitate (DNR)/Practitioner Orders for Life-Sustaining Treatment (POLST) form. It's a voluntary form for patients to record their medical treatment preferences. It includes sections for CPR, medical interventions, nutrition, and documentation of discussion.
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How do I fill this out?
To complete the DNR/POLST form, follow these steps carefully. Ensure all required sections are filled based on the patient's medical condition and preferences. Make sure it is signed and witnessed to be valid.
How to fill out the Illinois DNR/POLST Form for Life-Sustaining Treatment?
1
Enter patient information.
2
Select desired CPR and medical interventions.
3
Choose preferences for medically administered nutrition.
4
Document the discussion and obtain necessary signatures.
5
Submit the form as required, ensuring it’s reviewed periodically.
Who needs the Illinois DNR/POLST Form for Life-Sustaining Treatment?
1
Patients who want to document their medical treatment preferences.
2
Health care professionals responsible for patient care.
3
Legal representatives tasked with conveying a patient's wishes.
4
Family members ensuring the medical preferences of their loved ones are honored.
5
Healthcare facilities needing accurate records of a patient’s treatment preferences.
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On PrintFriendly, you can easily edit the DNR/POLST form directly in your browser. Use our PDF editor to make changes to any section of the form to ensure it reflects the patient’s current treatment preferences. Save and download the updated version hassle-free.
1
Open the DNR/POLST form on PrintFriendly.
2
Use the PDF editor to enter patient information.
3
Select and update medical treatment preferences.
4
Ensure all signatures are added in the respective sections.
5
Save the edited form and download it.
What are the instructions for submitting this form?
Submit the completed DNR/POLST form to the appropriate healthcare provider or facility. Ensure copies are shared with the patient's primary physician and kept in the patient's medical records. If electronic records are maintained, follow your facility's guidelines for submitting and storing the form.
What are the important dates for this form in 2024 and 2025?
The form needs periodic review and updating as the patient's situation or preferences change. Ensure the form is current during transfers or significant health changes.
What is the purpose of this form?
The Illinois DNR/POLST form serves as a critical document for patients to record their medical treatment preferences in emergency situations. It ensures healthcare professionals are aware of and can honor these wishes, providing peace of mind to patients and their families. By clearly documenting desired and undesired treatments, the form helps prevent unnecessary or unwanted medical interventions.
Tell me about this form and its components and fields line-by-line.
- 1. Patient Information: Includes fields for patient’s name, date of birth, and address.
- 2. CPR Preferences: Options for attempting or not attempting resuscitation.
- 3. Medical Interventions: Choices between full treatment, selective treatment, and comfort-focused treatment.
- 4. Nutrition: Preferences for medically administered nutrition, including options for long-term feeding tubes.
- 5. Documentation of Discussion: Signatures from the patient, legal representative, witness, and attending practitioner.
What happens if I fail to submit this form?
Failing to submit or complete the DNR/POLST form may result in default medical interventions being applied during emergencies.
- Unwanted Medical Interventions: Without a completed form, healthcare providers may proceed with treatments that the patient may not want.
- Legal Confusion: Absence of a valid form may lead to legal challenges or confusion in emergency situations.
How do I know when to use this form?
- 1. Severe Health Conditions: Use this form if the patient has a life-threatening condition and specific treatment preferences.
- 2. End-of-Life Care: For documenting wishes about treatments during end-of-life care.
- 3. Legal Requirement: When legal documentation of medical preferences is required.
Frequently Asked Question
How can I edit the DNR/POLST form on PrintFriendly?
Use our PDF editor to enter patient information, select treatment preferences, and add signatures directly on the form.
Can I digitally sign the DNR/POLST form on PrintFriendly?
Yes, you can add digital signatures to the form using our PDF editor for authenticity.
How do I share the DNR/POLST form?
After completing and editing, use our sharing features to send the form electronically via email or link.
Is the form legally valid if edited and signed digitally?
Yes, digitally edited and signed forms are considered legally valid under applicable laws.
Can I update the form after submission?
Yes, you can edit and resubmit the form to reflect any changes in treatment preferences.
How do I know which sections need to be completed?
Follow the form instructions and ensure all required sections related to patient information and medical preferences are filled.
Can I use a photocopied version of the form?
Yes, photocopies and faxes on any color paper are legal and valid forms.
Who needs to sign the form for it to be valid?
The patient or legal representative, a witness, and the attending practitioner must sign the form.
How often should the form be reviewed?
The form should be reviewed periodically, especially when the patient is transferred, their health status changes, or their primary care professional changes.
What happens if the form needs to be voided or revoked?
Draw a line through sections A through E, write 'VOID' across the page, and include the date and signatures to void or revoke the form.
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