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Texas Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is made in accordance with Texas state law, specifically the Texas Health and Safety Code, Chapter 166. This document expresses the wishes of the person named below regarding their medical treatment in the event of a cardiac arrest or severe medical emergency.

Patient Information:

  • Name: _______________________________
  • Date of Birth: ______________________
  • Address: _____________________________
  • Phone Number: _______________________

Health Care Agent Information:

  • Name: _______________________________
  • Relationship: ________________________
  • Phone Number: _______________________

This order indicates that the patient has made the decision not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining treatments in the event of a medical emergency where their heart stops beating and they stop breathing. This order is valid under the circumstances outlined below:

  1. The patient is diagnosed with a terminal condition or is in a state of irreversible decline.
  2. The patient is unable to communicate their wishes regarding resuscitation.
  3. The decision has been made voluntarily and without coercion.

Signature of Patient or Health Care Agent:

_______________________________

Printed Name:

_______________________________

Date of Signature:

_______________________________

Witness Information:

  • Name: _______________________________
  • Signature: ____________________________
  • Date: ______________________________

This document should be placed in a location where it can be easily accessed by medical personnel or healthcare providers. It is important to review this order periodically to ensure it reflects the patient's current wishes.

Documents used along the form

When considering end-of-life care options, the Texas Do Not Resuscitate (DNR) Order form is just one important document. It’s often accompanied by several other forms that help clarify a person’s wishes regarding medical treatment. Here’s a brief overview of some of these documents:

  • Advance Directive: This is a legal document that allows individuals to outline their preferences for medical treatment in case they become unable to communicate their wishes. It can include directives about life-sustaining treatments and appointing a healthcare proxy.
  • Medical Power of Attorney: This document designates a specific person to make healthcare decisions on behalf of someone if they are unable to do so. It ensures that someone trusted can advocate for the individual's wishes.
  • Living Will: A living will specifies what types of medical treatment a person does or does not want in situations where they are terminally ill or incapacitated. It provides clear guidance to healthcare providers and family members.
  • Physician Orders for Life-Sustaining Treatment (POLST): This is a medical order that outlines a patient’s preferences for life-sustaining treatments. Unlike an advance directive, it is intended to be actionable by healthcare providers and is often used for patients with serious illnesses.
  • Do Not Intubate (DNI) Order: This order specifies that a patient does not wish to be intubated if they are unable to breathe on their own. It is often used in conjunction with a DNR order.
  • Organ Donation Consent Form: This document allows individuals to express their wishes regarding organ donation after death. It can be an important part of end-of-life planning and can be included with other advance directives.
  • Motor Vehicle Bill of Sale Form: For those navigating vehicle transactions, the comprehensive Motor Vehicle Bill of Sale requirements provide crucial documentation to ensure legal compliance.
  • Healthcare Proxy Designation: Similar to a medical power of attorney, this document appoints someone to make healthcare decisions for an individual when they are not able to communicate their preferences.
  • Patient Advocate or Ombudsman Form: This form designates a patient advocate or ombudsman to help navigate healthcare decisions and ensure that the patient’s rights and preferences are respected.

Each of these documents serves a unique purpose and can provide clarity and peace of mind during difficult times. Having them in place can ensure that your healthcare wishes are honored, making it easier for loved ones and medical professionals to understand your preferences.

Similar forms

  • Living Will: A living will outlines an individual's preferences for medical treatment in situations where they cannot communicate. Like a DNR, it focuses on end-of-life care.
  • Durable Power of Attorney for Healthcare: This document designates a person to make healthcare decisions on behalf of someone else. It can include DNR preferences and other medical directives.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that specifies a patient's wishes regarding treatments like resuscitation. It is similar to a DNR but can cover a broader range of medical interventions.
  • Durable Power of Attorney: This document allows an individual to grant authority to another person to make decisions on their behalf, similar to a healthcare proxy. For more details, you can refer to the Durable Power of Attorney form.
  • Advance Healthcare Directive: This document combines a living will and a durable power of attorney, allowing individuals to express their medical preferences and appoint someone to make decisions for them.
  • Do Not Intubate (DNI) Order: A DNI order specifically indicates that a patient does not wish to be intubated. It is often used alongside a DNR order to clarify treatment preferences.
  • Emergency Medical Services (EMS) Do Not Resuscitate Order: This is a specific form used by EMS personnel to honor a DNR in emergency situations outside of a hospital setting.
  • Comfort Care Order: This order focuses on providing comfort rather than aggressive treatment. It aligns with the goals of a DNR by prioritizing quality of life over prolonging life.
  • Healthcare Proxy: A healthcare proxy designates someone to make medical decisions on behalf of another person. It can include instructions related to resuscitation and other life-sustaining measures.

Misconceptions

Many people hold misconceptions about the Texas Do Not Resuscitate (DNR) Order form. Understanding the facts can help clarify its purpose and usage. Here are six common misconceptions:

  1. A DNR order means no medical treatment at all. This is not true. A DNR order specifically addresses resuscitation efforts in the event of cardiac arrest. Patients can still receive other forms of medical treatment and care.
  2. Only terminally ill patients can have a DNR order. This misconception is misleading. Anyone can request a DNR order, regardless of their health status, as long as they understand the implications.
  3. A DNR order is permanent and cannot be changed. This is incorrect. Patients or their authorized representatives can revoke or modify a DNR order at any time, as long as they communicate their wishes clearly.
  4. Healthcare providers must follow a DNR order in all situations. While healthcare providers generally respect a DNR order, they may still provide life-saving measures in specific situations, such as when a patient is in a hospital and requires different interventions.
  5. A DNR order is the same as a living will. These two documents serve different purposes. A living will outlines a person's wishes regarding medical treatment in various scenarios, while a DNR specifically addresses resuscitation efforts.
  6. DNR orders are only for the elderly. This is a common misunderstanding. DNR orders can be appropriate for individuals of any age who wish to express their preferences about resuscitation.

Being informed about these misconceptions can help individuals make better decisions regarding their healthcare preferences.

Understanding Texas Do Not Resuscitate Order

  1. What is a Texas Do Not Resuscitate Order (DNR)?

    A Texas Do Not Resuscitate Order is a legal document that allows a person to refuse resuscitation efforts in the event of a medical emergency. This order specifically instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if the person’s heart stops or they stop breathing.

  2. Who can create a DNR in Texas?

    In Texas, a DNR can be created by any adult who is capable of making their own healthcare decisions. Additionally, a legally authorized representative can create a DNR on behalf of someone who is unable to make decisions due to incapacity.

  3. How do I obtain a DNR form in Texas?

    The DNR form can be obtained from various sources, including hospitals, healthcare providers, and online resources. It is important to ensure that the form is the official Texas DNR form, as it must meet specific state requirements to be valid.

  4. What information is required on the DNR form?

    The DNR form typically requires the patient's name, date of birth, and the signature of the patient or their authorized representative. It may also require the signature of a physician to validate the order. Other identifying information, such as the patient's medical record number, may be included as well.

  5. Is a DNR order valid in all healthcare settings?

    Yes, a valid Texas DNR order is recognized in various healthcare settings, including hospitals, nursing homes, and at home. However, it is advisable to communicate your wishes to all healthcare providers involved in your care to ensure that the order is respected.

  6. Can a DNR order be revoked?

    Yes, a DNR order can be revoked at any time. The individual or their authorized representative can simply destroy the form or provide written notice to healthcare providers that they wish to revoke the order. It is important to inform all relevant parties of this change.

  7. What happens if a DNR order is not followed?

    If a DNR order is not followed, it may lead to legal and ethical complications for the healthcare providers involved. Patients or their families may have grounds for complaints or legal action if the order is disregarded. Ensuring that the DNR form is properly documented and communicated can help prevent such situations.

  8. Are there any limitations to a DNR order?

    While a DNR order specifically addresses resuscitation efforts, it does not limit other medical treatments. Patients can still receive necessary medical care, such as pain management or comfort measures, even if a DNR order is in place. It is essential to discuss the full scope of care preferences with healthcare providers.