KANSAS OFFICE of
  REVISOR of STATUTES

  

Home >> Statutes >> Back


Click to open printable format in new window.Printable Format
 | Next

65-4942. Same; form. A "do not resuscitate" directive shall be in substantially the following form:

PRE-HOSPITAL DNR REQUEST FORM
An advanced request to Limit the Scope of
Emergency Medical Care

I, _________________, request limited emergency care as herein described.
              (Name)

I understand DNR means that if my heart stops beating or if I stop breathing, no medical procedure to restart breathing or heart functioning will be instituted.

I understand this decision will not prevent me from obtaining other emergency medical care by pre-hospital care providers or medical care directed by a physician prior to my death.

I understand I may revoke this directive at any time.

I give permission for this information to be given to the pre-hospital care providers, doctors, nurses or other health care personnel as necessary to implement this directive.

I hereby agree to the "Do Not Resuscitate" (DNR) directive.

_______________________________
                   Signature

_______________________________
Date                            

_______________________________
                   Witness

_______________________________
Date                            

I AFFIRM THIS DIRECTIVE IS THE EXPRESSED WISH OF THE PATIENT, IS MEDICALLY APPROPRIATE, AND IS DOCUMENTED IN THE PATIENT'S PERMANENT MEDICAL RECORD.

In the event of an acute cardiac or respiratory arrest, no cardiopulmonary resuscitation will be initiated.

_______________________________________________
                   Attending Physician's or
           Physician Assistant's Signature*

_______________________________
Date                            

_______________________________________________
                                      Address

_______________________________
Date                            

*Signature of physician or physician assistant not required if the above-named is a member of a church or religion which, in lieu of medical care and treatment, provides treatment by spiritual means through prayer alone and care consistent therewith in accordance with the tenets and practices of such church or religion.

REVOCATION PROVISION
I hereby revoke the above declaration.

_______________________________
                   Signature

_______________________________
Date                            

History: L. 1994, ch. 143, § 2; L. 2015, ch. 46, § 17; July 1.


 | Next


LEGISLATIVE COORDINATING COUNCIL
  12/17/2024 Meeting Notice Agenda
  12/02/2024 Meeting Notice Agenda
  11/14/2024 Meeting Notice Agenda
  10/23/2024 Meeting Notice Agenda
  09/09/2024 Meeting Notice Agenda
  08/21/2024 Meeting Notice Agenda

  LCC Policies

REVISOR OF STATUTES
  Chapter 72 Statute Transfer List
  Kansas School Equity & Enhancement Act
  Gannon v. State
  A Summary of Special Sessions in Kansas
  Bill Brief for Senate Bill No. 1
  Bill Brief for House Bill No. 2001
  2024 New, Amended & Repealed Statutes By Bill
  2024 New, Amended & Repealed Statutes By KSA
  2023 New, Amended & Repealed Statutes By Bill
  2023 New, Amended & Repealed Statutes By KSA
USEFUL LINKS
Session Laws

OTHER LEGISLATIVE SITES
Kansas Legislature
Administrative Services
Division of Post Audit
Research Department