Fillable  Do Not Resuscitate Order Template for Texas Launch Do Not Resuscitate Order Editor Now

Fillable Do Not Resuscitate Order Template for Texas

A Texas Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. This form ensures that healthcare providers respect a person's decision to forgo life-saving measures such as CPR. Understanding the implications of this form is crucial for individuals and their families, especially during critical health situations. To take the next step in expressing your healthcare preferences, consider filling out the form by clicking the button below.

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Dos and Don'ts

When filling out the Texas Do Not Resuscitate Order form, there are important guidelines to follow. Here are five things to do and five things to avoid:

  • Do: Ensure that the form is signed by the patient or their legal representative.
  • Do: Clearly indicate the patient's name and date of birth on the form.
  • Do: Review the form for accuracy before submission.
  • Do: Keep a copy of the completed form for personal records.
  • Do: Discuss the decision with family members and healthcare providers.
  • Don't: Leave any sections of the form blank.
  • Don't: Use the form without understanding its implications.
  • Don't: Forget to update the form if the patient's wishes change.
  • Don't: Assume that verbal instructions are sufficient; written documentation is necessary.
  • Don't: Misplace the form; it should be easily accessible to healthcare providers.

Sample - Texas Do Not Resuscitate Order Form

Texas Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is prepared in accordance with Texas law regarding advance directives. It expresses the wishes of the Patient named below regarding the use of resuscitation measures in case of a medical emergency.

Patient Information:

  • Name: _______________________________
  • Date of Birth: ______________________
  • Medical Record Number: ____________

Physician Information:

  • Physician's Name: ________________________
  • Practice Address: _______________________
  • Phone Number: _________________________

Statement of Wishes:

I, the undersigned Patient, have made the following decisions regarding my medical care:

  1. I do not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
  2. This order does not apply in cases where I am not in cardiac or respiratory arrest.

Signature:

By signing below, I confirm that I understand the implications of this Do Not Resuscitate Order and that I have made my decision voluntarily.

__________________________

Signature of Patient or Authorized Representative

__________________________

Date:

Witness Information:

  • Name of Witness: ________________________
  • Signature of Witness: _____________________
  • Date: ___________________________________

Documents used along the form

The Texas Do Not Resuscitate Order (DNR) form is an important document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. Alongside the DNR, there are several other forms and documents that can provide additional clarity and guidance regarding healthcare preferences. Here are some commonly used documents:

  • Advance Directive: This document outlines a person's healthcare preferences in situations where they cannot communicate their wishes. It may include instructions on medical treatments and appoint a healthcare proxy to make decisions on their behalf.
  • Medical Power of Attorney: This form designates a specific person to make medical decisions for someone if they become incapacitated. It ensures that a trusted individual can advocate for the patient's wishes.
  • Living Will: A living will details the types of medical treatment a person wishes to receive or avoid in end-of-life situations. It serves as a guide for healthcare providers and family members.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that specifies a patient's preferences for life-sustaining treatments. It is intended for individuals with serious illnesses or those nearing the end of life.
  • Organ Donation Form: This document indicates a person's wishes regarding organ and tissue donation after death. It can be part of a driver's license or a separate form.
  • Do Not Intubate (DNI) Order: This order specifies that a patient should not be intubated if they experience respiratory failure. It complements the DNR by addressing specific interventions.

Having these documents in place can help ensure that healthcare providers and family members understand and respect a person's wishes regarding medical treatment. It is advisable to discuss these documents with loved ones and healthcare professionals to ensure everyone is on the same page.

Common mistakes

Filling out the Texas Do Not Resuscitate (DNR) Order form requires careful attention to detail. One common mistake is failing to provide clear identification of the patient. The form must include the patient's full name and date of birth. Omitting this information can lead to confusion and may result in emergency personnel not honoring the DNR wishes.

Another frequent error involves the signature. The form must be signed by the patient or their legally authorized representative. Some individuals mistakenly assume that a verbal agreement suffices. Without a proper signature, the DNR order may not be recognized, potentially leading to unwanted resuscitation efforts.

Additionally, individuals often overlook the need for witness signatures. In Texas, the DNR Order must be witnessed by two adults who are not related to the patient or entitled to any portion of the patient’s estate. Failing to obtain these signatures can invalidate the order, leaving the patient's preferences unprotected.

Lastly, people sometimes neglect to communicate their DNR status to family members and healthcare providers. It is crucial to inform those involved in the patient's care about the existence of the DNR Order. Without this communication, there may be confusion during a medical emergency, leading to actions that contradict the patient's wishes.

Misconceptions

The Texas Do Not Resuscitate (DNR) Order form is often misunderstood. Here are some common misconceptions that people have about it:

  • A DNR means I don’t want any medical treatment. This is not true. A DNR specifically addresses resuscitation efforts, not all medical care. Patients can still receive other forms of treatment.
  • Only terminally ill patients need a DNR. While many people with terminal conditions choose to have a DNR, anyone can request one based on their personal wishes regarding resuscitation.
  • A DNR is only valid in hospitals. This misconception is incorrect. In Texas, a DNR can be honored in various settings, including homes and long-term care facilities.
  • Having a DNR means I will receive no care at all. This is false. Healthcare providers will still provide comfort care and pain management, even if resuscitation is not desired.
  • I can’t change my mind once I have a DNR. This is not the case. Individuals can revoke or modify their DNR orders at any time, as long as they are mentally competent to do so.
  • A DNR is a legal document that requires witnesses. In Texas, a DNR does not need to be witnessed to be valid. However, it must be signed by the patient or their legal representative.
  • All DNR orders are the same across states. This is misleading. Each state has its own laws and forms regarding DNR orders, so it’s essential to use the correct form for Texas.
  • If I have a DNR, my family cannot make decisions for me. This is not accurate. Family members can still be involved in care decisions, but a DNR specifically outlines the patient’s wishes regarding resuscitation.
  • Once I fill out a DNR, it stays with me forever. This is incorrect. DNR orders can be updated or changed as a person's health status or wishes evolve.

Understanding these misconceptions can help individuals make informed decisions about their healthcare preferences.

Key takeaways

Filling out a Texas Do Not Resuscitate (DNR) Order form is an important step in expressing your medical preferences. Here are some key takeaways to consider:

  • The DNR form must be signed by a physician. This ensures that your wishes are documented and legally recognized.
  • It is crucial to discuss your decision with family members and healthcare providers. Open communication can help prevent confusion during critical moments.
  • The DNR order should be easily accessible. Keep a copy in your medical records and share it with your loved ones and healthcare team.
  • Review and update the DNR order as needed. Changes in health status or personal preferences may require adjustments to the document.
  • Understand that a DNR order only applies to resuscitation efforts. It does not affect other medical treatments or care you may wish to receive.

Taking these steps can help ensure that your healthcare preferences are honored when it matters most.

PDF Information

Fact Name Description
Definition A Texas Do Not Resuscitate Order (DNR) is a legal document that indicates a person's wish to not receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
Governing Law The Texas DNR Order is governed by Texas Health and Safety Code, Chapter 166.
Eligibility Any adult who is capable of making their own medical decisions can complete a DNR order.
Signature Requirement The DNR form must be signed by the patient or their legally authorized representative.
Physician's Signature A physician must also sign the DNR order, confirming that the patient has made an informed decision.
Emergency Medical Services Emergency medical personnel are required to honor a valid DNR order during emergencies.
Form Availability The Texas DNR order form is available through hospitals, healthcare providers, and online resources.
Revocation A DNR order can be revoked at any time by the patient or their representative, verbally or in writing.
Documentation It is essential to keep a copy of the DNR order in a visible place, such as on the refrigerator or with medical records.
Related Documents Individuals may also consider creating an advance directive or living will to outline other healthcare wishes.

How to Use Texas Do Not Resuscitate Order

Completing the Texas Do Not Resuscitate Order (DNR) form is an important step for individuals who wish to communicate their healthcare preferences regarding resuscitation efforts. This process allows you to express your wishes clearly and ensure that your healthcare team understands your choices. Follow the steps below to fill out the form accurately.

  1. Begin by obtaining the Texas Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
  2. Read the instructions carefully to understand the information required on the form.
  3. Fill in your full name, date of birth, and address at the top of the form.
  4. Provide the name and contact information of your healthcare provider, if applicable.
  5. Clearly indicate your wishes regarding resuscitation by selecting the appropriate option on the form.
  6. If you have a legal representative, include their name and contact information as well.
  7. Sign and date the form to confirm your choices.
  8. Have your healthcare provider or a witness sign the form, as required.
  9. Make copies of the completed form for your records and share it with your healthcare provider and family members.

Once you have completed the form, it is essential to keep it in a safe place and ensure that your loved ones are aware of its location. This will help facilitate your wishes being honored in a medical situation where they may be needed.