Ala. Admin. Code r. 420-5-19-.02

Current through Register Vol. 43, No. 1, October 31, 2024

Section 420-5-19-.02 - Portable Physician Do Not Attempt Resuscitation Orders

(1) Definitions.

(a) Do Not Attempt Resuscitation (DNAR) Order. A physician's order that resuscitative measures not be provided to a person under a physician's care in the event the person is found with cardiopulmonary cessation. A DNAR order would include, without limitation, physician orders written as "do not resuscitate," "do not allow resuscitation," "do not allow resuscitative measures," "DNAR," "DNR," "allow natural death," or "AND." A DNAR order must be entered with the consent of the person, if the person is competent; or in accordance with instructions in an advance directive if the person is not competent or is no longer able to understand, appreciate, and direct his or her medical treatment and has no hope of regaining that ability; or with the consent of a health care proxy or surrogate functioning under the provisions of Title 22, Chapter 8A, Code of Ala. 1975; or instructions by an attorney in fact under a durable power of attorney that duly grants powers to the attorney in fact to make those decisions described in Section 22-8 A-4(b)(1), Code of Ala. 1975.

(b) Portable Physician DNAR Order. A DNAR order entered into the medical record by a physician using the required form designated by this rule and substantiated by completion of all applicable sections of the form.

(2) Physicians intending to enter a portable physician DNAR order shall utilize the form attached hereto as Appendix 2 which, when properly completed and executed, shall constitute the portable physician DNAR order as authorized by Act 2016-96. An electronic version of the form with same content may be utilized.

(3) Portable physician DNAR orders issued in accordance with this rule shall remain valid and in effect until revoked pursuant to Section 22-8 A-5, Code of Ala. 1975, or by other recognized means. Qualified emergency medical services personnel and licensed health care practitioners in any facility, program, or organization including those operated, licensed, or owned by another state agency are authorized to follow portable physician DNAR orders that are available, known to them, and executed in accordance with this rule.

(4) If a person with a portable physician DNAR order is transferred from one health care facility to another health care facility, the health care facility initiating the transfer shall communicate the existence of the order to the receiving facility prior to or during the transfer. The transferring facility shall assure that a copy of the order accompanies the patient in transport to the receiving health care facility. Upon admission, the receiving facility shall make the order a part of the patient's permanent medical record.

(5) This rule does not prevent, prohibit, or limit a physician from issuing a facility-specific written order, other than a portable physician DNAR order, not to resuscitate a patient in accordance with accepted medical practices in the event of cardiopulmonary cessation. A facility-specific DNAR order is not a portable physician DNAR order and does not transfer with the patient to another health care facility.

(6) DNAR orders issued before the effective date of this rule shall remain valid as a facility-specific DNAR order.

Ala. Admin. Code r. 420-5-19-.02

Adopted by Alabama Administrative Monthly Volume XXXIV, Issue No. 11, August 31, 2016, eff. 10/3/2016.

Author: Walter T. Geary Jr., M.D.

Statutory Authority: Act 2016-96.