IC 16-36-5-13
Transfer of patient to another physician
Sec. 13. (a) An attending physician who does not issue an out of
hospital DNR order for a patient who is a qualified person may transfer
the patient to another physician, who may issue an out of hospital DNR
order, unless:
(1) the attending physician has reason to believe the patient's
declaration was not validly executed, or there is evidence the patient no
longer intends the declaration to be enforced; and
(2) the patient is unable to validate the declaration.
(b) Notwithstanding section 10 of this chapter, if an attending
physician, after reasonable investigation, does not find any other
physician willing to honor the patient's out of hospital DNR
declaration and issue an out of hospital DNR order, the attending
physician may refuse to issue an out of hospital DNR order.
(c) If the attending physician does not transfer a patient under
subsection (a), the attending physician may attempt to ascertain the
patient's intent and attempt to determine the validity of the declaration
by consulting with any of the following individuals who are reasonably
available, willing, and competent to act:
(1) A court appointed guardian of the patient, if one has been
appointed. This subdivision does not require the appointment of a guardian
so that a treatment decision may be made under this section.
(2) A person designated by the patient in writing to make a
treatment decision.
(3) The patient's spouse.
(4) An adult child of the patient or a majority of any adult
children of the patient who are reasonably available for consultation.
(5) An adult sibling of the patient or a majority of any adult
siblings of the patient who are reasonably available for consultation.
(6) The patient's clergy.
(7) Another person who has firsthand knowledge of the patient's
intent.
(d) The individuals described in subsection (c)(1) through (c)(7)
shall act in the best interest of the patient and shall follow the
patient's express or implied intent, if known.
(e) The attending physician acting under subsection (c) shall list the
names of the individuals described in subsection (c) who were consulted
and include the information received in the patient's medical file.
(f) If the attending physician determines from the information
received under subsection (c) that the patient intended to execute a valid
out of hospital DNR declaration, the attending physician may:
(1) issue an out of hospital DNR order, with the concurrence of at
least one (1) physician documented in the patient's medical file; or
(2) request a court to appoint a guardian for the patient to make
the consent decision on behalf of the patient.
(g) An out of hospital DNR order must be issued on the form specified
in section 15 of this chapter.
As added by P.L.148-1999, SEC.12.
IC 16-36-5-15
Form
Sec. 15. An out of hospital DNR declaration and order must be in
substantially the following form:
OUT OF HOSPITAL DO NOT RESUSCITATE DECLARATION
AND ORDER
This declaration and order is effective on the date of execution and
remains in effect until the death of the declarant or revocation.
OUT OF HOSPITAL DO NOT RESUSCITATE DECLARATION
Declaration made this ____ day of __________. I, _____________, being of
sound mind and at least eighteen (18) years of age, willfully and
voluntarily make known my desires that my dying shall not be artificially
prolonged under the circumstances set forth below. I declare:
My attending physician has certified that I am a qualified person,
meaning that I have a terminal condition or a medical condition such that,
if I suffer cardiac or pulmonary failure, resuscitation would be
unsuccessful or within a short period I would experience repeated cardiac
or pulmonary failure resulting in death.
I direct that, if I experience cardiac or pulmonary failure in a
location other than an acute care hospital or a health facility,
cardiopulmonary resuscitation procedures be withheld or withdrawn and that
I be permitted to die naturally. My medical care may include any medical
procedure necessary to provide me with comfort care or to alleviate pain.
I understand that I may revoke this out of hospital DNR declaration at
any time by a signed and dated writing, by destroying or canceling this
document, or by communicating to health care providers at the scene the
desire to revoke this declaration.
I understand the full import of this declaration.
Signed___________________________________
Printed name______________________________
_________________________________________
City and State of Residence___________________
The declarant is personally known to me, and I believe the declarant
to be of sound mind. I did not sign the declarant's signature above, for,
or at the direction of, the declarant. I am not a parent, spouse, or child
of the declarant. I am not entitled to any part of the declarant's estate
or directly financially responsible for the declarant's medical care. I am
competent and at least eighteen (18) years of age.
Witness____________Printed name___________Date__________
Witness____________Printed name___________Date__________
OUT OF HOSPITAL DO NOT RESUSCITATE ORDER
I,___________________, the attending physician of _________________,
have certified the declarant as a qualified person to make an out of
hospital DNR declaration, and I order health care providers having actual
notice of this out of hospital DNR declaration and order not to initiate
or continue cardiopulmonary resuscitation procedures on behalf of the
declarant,
unless the out of hospital DNR declaration is revoked.
Signed_____________________Date__________
Printed name______________________________
Medical license number_____________________
As added by P.L.148-1999, SEC.12.
IC 16-36-5-18
Revocation
Sec. 18. (a) A declarant may at any time revoke an out of
hospital DNR declaration and order by any of the following:
(1) A signed, dated writing.
(2) Physical cancellation or destruction of the declaration and
order by the declarant or another in the declarant's presence and at the
declarant's direction.
(3) An oral expression by the declarant of intent to revoke.
(b) A declarant's representative may revoke an out of hospital DNR
declaration and order under this chapter only if the declarant is
incompetent.
(c) A revocation is effective upon communication to a health care
provider.
(d) A health care provider to whom the revocation of an out of
hospital DNR declaration and order is communicated shall immediately
notify the declarant's attending physician, if known, of the revocation.
(e) An attending physician notified of the revocation of an out of
hospital DNR declaration and order shall immediately:
(1) add the revocation to the declarant's medical file, noting the
time, date, and place of revocation, if known, and the time, date, and
place that the physician was notified;
(2) cancel the out of hospital DNR declaration and order by
entering the word "VOID" on each page of the out of hospital DNR
declaration and order in the declarant's medical file; and
(3) notify any health care facility staff responsible for the
declarant's care of the revocation.
As added by P.L.148-1999, SEC.12.
