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Louisiana Do Not Resuscitate (DNR) Order Form

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Louisiana Do Not Resuscitate (DNR) Order Form

Updated July 19, 2023

A Louisiana Do Not Resuscitate (DNR or DNAR) order form instructs any medical professional dealing with a patient not to resuscitate them in the event that they enter cardiac arrest. This document is issued by the patient’s doctor after consulting with the patient or their authorized representative. In Louisiana, the DNR order is included in the Louisiana Physician Orders for Scope of Treatment (LaPOST) form, which details multiple instructions as to how the patient wishes to be treated given different critical medical circumstances.

Laws – § 40:1155.3

Required to Sign – Physician and patient (or their authorized personal health care representative) must both sign.

How to Write

Step 1 – Download in PDF.

Step 2 – In the upper section of the form, provide the patient’s full name and their terminal diagnosis in the indicated fields.

Step 3 – In Section A, select the appropriate checkbox to indicate whether or not the patient requests CPR treatment or wishes to issue a DNR order.

Step 4 – In Sections B, C, and D, you will indicate what types of medical interventions, antibiotics, and artificially administered fluids/nutrition the patient authorizes to be used in their treatment.

Step 5 – Any further instructions that need to be added to this form can be written into Section E.

Step 6 – In Section F, you will need to check the appropriate checkboxes in order to indicate who you have discussed this matter with and what the basis for this decision is/was.

Step 7 – At the bottom of the first page, provide your printed name, signature, phone number, the signature of the patient (or personal health care representative), and the date. If a personal health care representative signed this form, you must describe their authority to act on behalf of the patient in the appropriate space.

Step 8 – This form should be regularly reviewed to ensure that it is still in line with the patient’s wishes. Each time a review is made, the date and time, the name of the reviewer, and the location of review must be entered in the indicated fields. If the patient wishes to void this form, check the appropriate box to render this form inactive.