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Texas Do Not Resuscitate Order
This Do Not Resuscitate (DNR) Order is in accordance with Texas Health and Safety Code §166.033. This order expresses the wishes of the individual regarding medical resuscitation efforts in the event of a medical emergency.
Patient Information:
- Name: ______________________________
- Date of Birth: _______________________
- Address: _____________________________
- City: _________________________________
- State: Texas
- Zip Code: ____________________________
Healthcare Agent Information:
- Name: ______________________________
- Relationship to Patient: ______________
- Phone Number: ______________________
Order Statement:
I, the undersigned, hereby declare that I do not wish to receive resuscitation attempts, including but not limited to cardiopulmonary resuscitation (CPR) or advanced cardiac life support (ACLS). This directive shall remain in effect until revoked in writing.
Signatures:
Patient Signature: ________________________ Date: ____________
Healthcare Agent Signature: ______________ Date: ____________
Witnesses:
- Witness Name: ________________________ Signature: ___________________
- Witness Name: ________________________ Signature: ___________________
This DNR Order is effective immediately and remains valid until a change is indicated. Please ensure that this document is accessible to all medical providers involved in the patient’s care.
Form Data
| Fact Name | Description |
|---|---|
| Definition | A Texas Do Not Resuscitate Order (DNR) is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in case of cardiac arrest. |
| Governing Law | The Texas DNR is governed by Texas Health and Safety Code, Chapter 166. |
| Eligibility | Any adult can complete a DNR order, or it can be completed by a legal guardian or a person with medical power of attorney. |
| Signature Requirement | The DNR form must be signed by the patient or their legal representative, as well as by a physician. |
| Form Accessibility | The Texas DNR form is available online through the Texas Department of State Health Services website. |
| Revocation | A DNR order can be revoked at any time by the patient or their representative, either verbally or in writing. |
| Emergency Medical Services | Emergency medical services (EMS) must honor a valid DNR order in the field, provided it is properly completed and signed. |
| Storage and Visibility | It is crucial to keep the DNR order in an accessible location, such as on the refrigerator or with medical records, to ensure it can be easily found during emergencies. |
Texas Do Not Resuscitate Order - Usage Guidelines
Filling out the Texas Do Not Resuscitate Order form is an important step for individuals who wish to express their healthcare preferences. Once completed, this document helps ensure that your wishes are respected in medical situations where resuscitation may be considered.
- Obtain the Texas Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
- Read the form carefully. Make sure you understand all sections before filling it out.
- Fill in your full name, date of birth, and other personal information as required on the form.
- Indicate your wishes regarding resuscitation by checking the appropriate box. This usually includes options for “Do Not Resuscitate” or “Allow Resuscitation.”
- Sign and date the form. Ensure that your signature is clear and matches your name on the form.
- Have a witness sign the form. This witness should not be a family member or someone who would benefit from your decisions.
- Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and family members.
- Discuss your wishes with your healthcare provider. Ensure they are aware of your preferences and have a copy of the form in your medical records.
Some Other Do Not Resuscitate Order State Templates
Dnr Form Pennsylvania - Can be modified as health status changes or as circumstances evolve.
What Does Dnr Mean - Posting a DNR in a visible location can help ensure quick identification during an emergency.
A Colorado Last Will and Testament form is a legal document that outlines how a person's assets and responsibilities should be handled after their death. This essential tool ensures that your wishes are honored and that your loved ones are taken care of according to your preferences. To assist in this process, you can access templates from Colorado PDF Templates, which provide a straightforward way to create a will that reflects your intentions clearly and effectively.
Can You Have a Dnr at Any Age - Healthcare providers are required to respect a valid DNR order during emergencies.
Dos and Don'ts
When filling out the Texas Do Not Resuscitate (DNR) Order form, it is important to approach the process with care and consideration. Here are some key things to keep in mind:
- Do ensure that you understand the implications of a DNR order. This document indicates that you do not want to receive CPR or other resuscitative measures in the event of a cardiac or respiratory arrest.
- Do consult with your healthcare provider. They can help clarify any questions you have about the form and its consequences for your medical care.
- Do discuss your wishes with your family. It is essential that your loved ones understand your preferences regarding end-of-life care.
- Don't fill out the form hastily. Take your time to consider your decision thoroughly before signing.
- Don't forget to sign and date the form. An unsigned DNR order may not be honored by medical personnel.
- Don't assume that a DNR order is permanent. You can revoke or change your wishes at any time, and it's important to communicate any updates to your healthcare team.
Common mistakes
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Not discussing the decision with healthcare providers. It's crucial to have conversations with your doctor or healthcare team before completing the form. They can provide guidance on the implications of a Do Not Resuscitate (DNR) order.
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Failing to communicate with family members. Family members should be informed about your wishes. This helps prevent confusion and ensures that everyone understands your decision regarding resuscitation.
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Not signing the form properly. Ensure that the DNR form is signed by you, or your legally authorized representative. A missing signature can render the document invalid.
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Inaccurate or incomplete information. Filling out the form with incorrect details, such as your name or date of birth, can lead to complications. Double-check all entries for accuracy.
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Not keeping copies of the form. After completing the DNR order, make sure to keep copies in accessible locations. Share these copies with your healthcare provider and family members to ensure your wishes are honored.