Attorney-Verified Do Not Resuscitate Order Form for the State of Oklahoma

Oklahoma Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is in accordance with the Oklahoma Do Not Resuscitate Act. It is a legal order, recognized in the state of Oklahoma, indicating that a person does not want to receive cardiopulmonary resuscitation (CPR) if their heart stops beating or they stop breathing. This form is to be filled out by the individual in question or their legally authorized representative.

Please fill in the required information:

1. Full Name of Patient: ________________________________________________
2. Date of Birth: ___________________________
3. Address: ____________________________________________________________
4. City: ________________________ State: Oklahoma Zip Code: _____________
5. Primary Physician (if any): ___________________________________________
6. Physician's Phone Number: ___________________________________________

This DNR order is made on the basis of the patient's directive or, if the patient is incapacitated, the directive of the patient's legally authorized representative. It is understood that this does not preclude the provision of other medical care, including comfort care, unless otherwise specified by the patient or the patient's legally authorized representative.

Signature Section:

Patient or Legally Authorized Representative Signature: __________________________________________

Date: _______________

Physician's Signature (required): _____________________________________________

Date: _______________

This document serves to ensure that the patient's wishes are respected and followed. Copies of this signed and completed form should be provided to the patient’s primary care provider, kept with the patient’s medical records, and given to any healthcare or residential facility where the patient receives care.

Please note that this form does not expire in Oklahoma unless the patient, or their legally authorized representative, revokes it. However, it is advisable to review and renew the form periodically, especially if the patient's medical condition changes.