{"ref":"MO-HH-PR-02","title":"Advance Directives, Durable Power of Attorney for Health Care, and Outside-the-Hospital Do-Not-Resuscitate Orders","category":"Client rights","summary":"Sets out how the Agency gives every adult patient written information about the right to accept or refuse treatment and to make advance directives before care is provided, records whether the patient has one, never conditions care on it, and follows Missouri law on life support declarations (RSMo Chapter 459), durable powers of attorney for health care (RSMo §§404.800 to 404.872) and outside-the-hospital do-not-resuscitate orders (RSMo §§190.600 to 190.621), including what staff do if a patient stops breathing.","inShort":["Give every adult patient the advance directive information before care starts, and record the answers.","Ask for a copy of any living will, durable power of attorney for health care or outside-the-hospital DNR order.","A DNR order is flagged on the record's opening screen and kept at the front of the home folder.","If a patient stops breathing: call 911, check for a DNR order or bracelet, and start CPR only if there is none.","Never pressure a patient to make, or not make, an advance directive. Care never depends on it.","Do not give legal advice or witness legal papers. Send questions to the clinical manager."],"primaryCitation":"42 CFR §489.102","citations":["RSMo §§459.010 to 459.055","RSMo §§404.800 to 404.872","RSMo §§190.600 to 190.621","19 CSR 30-26.010(1)(A)"],"federalCitations":["42 CFR §489.100","42 CFR §489.102","42 CFR §484.50(c)(4)","42 CFR §484.60(a)(2)(xv)"],"surveyorAsks":["Show me the written advance directive information you give patients. When is it given?","Where in the clinical record do you document whether the patient has an advance directive?"],"forms":[{"ref":"MO-HH-PR-02-A","title":"Advance Directive Information and Acknowledgment"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (42 CFR §489.102; RSMo Chapter 459; RSMo §§404.800 to 404.872; RSMo §§190.600 to 190.621)","5. Giving the Information","6. When the Patient Is Incapacitated at the Start of Care","7. Recording the Patient's Choices","8. No Conditions on Care","9. Missouri Advance Directive Documents","9.1 Missouri Life Support Declarations","9.2 Durable Power of Attorney for Health Care","10. Outside-the-Hospital Do-Not-Resuscitate Orders","11. When a Patient Is Found Not Breathing or Without a Pulse","12. Conscience Objections and Transfers","13. Complaints, Staff Education, and Community Education","14. Responsibilities","15. Records and Compliance Monitoring","16. Staff Training","17. References","18. Related Policies and Forms","19. Approval","20. Revision History"],"version":"1.0","sample":false,"pack":"mo-hha","state":"Missouri","service":"Home health","guides":[{"path":"/guides/home-health-agency-policies/","h1":"What policies and procedures are required for home health agencies?"},{"path":"/guides/home-health-conditions-of-participation/","h1":"Home health Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}