{"ref":"MO-HSP-PR-03","title":"Advance Directives, Outside-the-Hospital DNR Orders and Health Care Decision-Makers","category":"Client rights","summary":"Explains how the Agency meets state and federal advance directive law: the written information given at the start of care, with a summary of Missouri law on declarations (living wills), durable powers of attorney for health care and outside the hospital do-not-resuscitate (OHDNR) orders; documenting in a prominent place whether the patient has an advance directive; never conditioning care on having one; honoring directives, revocations and OHDNR orders; conscience objections; and staff and community education.","inShort":["At the first visit, give every adult patient the advance directive information form and ask if they have a living will, a health care power of attorney or an outside the hospital DNR order.","Record clearly at the front of the record whether the patient has an advance directive, and copy any document the patient has.","Never make a DNR order or an advance directive a condition of hospice care.","Keep any outside the hospital DNR order as the first page of the home folder, and send it with the patient on any transfer.","If a patient takes back an advance directive or now wants CPR, write down their words and tell the case manager and on-call nurse at once.","If there is no DNR order and the patient stops breathing, call 911, start CPR if trained, then call the on-call nurse."],"primaryCitation":"19 CSR 30-35.010(1)(E)4","citations":["19 CSR 30-35.010(1)(E)4","19 CSR 30-35.010(1)(D)2.B","RSMo §§459.010-459.055","RSMo §§404.800-404.872","RSMo §404.705","RSMo §§190.600-190.621","RSMo §191.250"],"federalCitations":["42 CFR §418.52(a)(2)","42 CFR §§489.100-489.104","42 CFR §489.102","42 CFR §418.104(a)(6)"],"surveyorAsks":["Where in this record do you document whether the patient has executed an advance directive?","What written information about Missouri advance directive law do you give patients, and when?"],"forms":[{"ref":"MO-HSP-PR-03-A","title":"Advance Directive Information and Acknowledgment"}],"headings":["Terms of Reference","1. Purpose","2. Scope","3. Definitions","4. Policy Statement (19 CSR 30-35.010(1)(E)4; 42 CFR §418.52(a)(2))","5. Information at the Start of Care","6. Missouri Law Staff Must Know","7. Honoring Advance Directives and Orders","8. Revocation and Review","9. Conscience Objections and Transfers","10. Patients in Facilities and Transfers","11. Staff and Community Education","12. Responsibilities","13. Records and Compliance Monitoring","14. Staff Training","15. References","16. Related Policies and Forms","17. Approval","18. Revision History"],"version":"1.0","sample":false,"pack":"mo-hospice","state":"Missouri","service":"Hospice","guides":[{"path":"/guides/hospice-policies/","h1":"What policies are required for hospice?"},{"path":"/guides/hospice-conditions-of-participation/","h1":"Hospice Conditions of Participation: which policies each one needs"}],"agency":{"name":"Sample Agency","legalName":"Sample Agency, LLC","logo":null}}