Alabama Administrative Code › Title 540 - ALABAMA BOARD OF MEDICAL EXAMINERS › Chapter 540-X-9 - MISCELLANEOUS › Section 540-X-9-.13 - Physician Issued Verbal Do Not Attempt Resuscitation (DNAR) Order

Current through Register Vol. 42, No. 9, June 28, 2024
(1) This rule is
			 promulgated pursuant to the Natural Death Act, Code of Ala. 1975, §
								22-8A-4.1(b)(2).
			 The intent of this rule is to provide for the issuance of a verbal DNAR Order
			 by a patient's attending physician, if the patient's attending physician is
			 unable to timely go to the facility where the patient is located, and the
			 patient's decision regarding the provision of resuscitative measures is known
			 but the DNAR Order has not been placed in the patient's medical record. It is
			 further the intent of this rule to prevent the provision of resuscitative
			 measures in violation of a patient's decision when the decision is known to the
			 attending physician but not yet entered into the patient's medical
			 record.
(2) The following
			 definitions will apply to these rules:
(a)
			 ATTENDING PHYSICIAN. The physician selected by, or assigned to, the patient who
			 has primary responsibility for the treatment and care of the patient.
(b) ADVANCE DIRECTIVE FOR HEALTH CARE. A
			 writing executed in accordance with Section
			 22-8A-4, Code of Alabama 1975,
			 which may include a living will, the appointment of a health care proxy, or
			 both such living will and appointment of a health care proxy.
(c) CARDIOPULMONARY CESSATION. A lack of
			 pulse or respiration.
(d) DNAR (DO
			 NOT ATTEMPT RESUSCITATION) 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 do not attempt resuscitation
			 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 Alabama 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
			 22-8A-4 (b) (1), Code of Alabama
			 1975.
(e) PORTABLE PHYSICIAN DNAR
			 ORDER (PORTABLE DNAR). A DNAR order, entered in the medical record by a
			 physician who has completed all sections of the required form designated by the
			 State Board of Health, that travels withs the patient should they transfer to
			 other healthcare facilities.
(f)
			 FACILITY SPECIFIC DNAR ORDER. A DNAR order, entered into the medical record by
			 an attending physician, that may only be acted upon at a specific facility
			 designated in the order.
(g) HEALTH
			 CARE PROVIDER. A person who is licensed, certified, registered, or otherwise
			 authorized by the law of this state to administer or provide health care in the
			 ordinary course of business or in the practice of a profession.
(h) HEALTH CARE PROXY. Any person designated
			 to act on behalf of an individual pursuant to Section
			 22-8A-4, Code of Alabama
			 1975.
(i) LIVING WILL. A witnessed
			 document in writing, voluntarily executed by the declarant, that gives
			 directions and may appoint a health care proxy, in accordance with the
			 requirements of Section
			 22-8A-4, Code of Alabama
			 1975.
(j) PATIENT. A terminally ill
			 or injured adult 19 years of age or over who is found with cardiopulmonary
			 cessation.
(k) RESUSCITATIVE
			 MEASURES. Those measures used to restore or support cardiac or respiratory
			 function in the event of cardiopulmonary cessation.
(l) SURROGATE. Any person appointed to act on
			 behalf of an individual pursuant to Section
			 22-8A-4, Code of Alabama
			 1975.