Texas PDF Templates

Texas PDF Templates
Homepage ➾ Attorney-Approved Texas Do Not Resuscitate Order Template
Contents

Form Example

Texas Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order is governed by Texas law, specifically under Chapter 166 of the Texas Health and Safety Code. Use this template to communicate a patient's wishes regarding resuscitative measures.

Please fill out the required information below:

  • Patient Name: ___________________________
  • Date of Birth: ___________________________
  • Address: ________________________________
  • Phone Number: __________________________
  • Health Care Provider: _____________________

By signing this form, the patient expresses their wish to forgo resuscitation attempts in the event of cardiac or respiratory arrest. Please indicate the understanding of the patient’s medical condition and intent:

Medical Condition: ______________________________________

The following parties need to acknowledge this document:

  1. Patient Signature: ___________________________ Date: ___________
  2. Surrogate Decision-Maker (if applicable): ____________________ Date: ___________
  3. Witness Signature: ___________________________ Date: ___________

This document should be presented to healthcare providers to ensure the patient's end-of-life preferences are honored.

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Common mistakes

  1. Not discussing the decision with family or healthcare providers: One of the most critical steps is to have open conversations about the decision to fill out a Do Not Resuscitate (DNR) order. Failing to do so can lead to confusion and conflict during a medical emergency.

  2. Inadequate understanding of the implications: Many people do not fully grasp what a DNR order entails. It’s essential to understand that it specifically applies to resuscitation efforts and does not affect other medical treatments.

  3. Incorrectly filling out the form: Mistakes in completing the DNR form can render it invalid. It is vital to ensure that all sections are filled out accurately, including signatures and dates.

  4. Not keeping copies accessible: After completing the DNR order, individuals often forget to make copies. Keeping a copy in an easily accessible location, such as with other important medical documents or with a healthcare proxy, is crucial.

  5. Neglecting to update the order: Life circumstances change, and so do personal wishes regarding medical care. Failing to revisit and update the DNR order can lead to situations where it no longer reflects an individual’s current preferences.

  6. Not informing emergency contacts: Even if the DNR order is properly filled out, it is ineffective if emergency personnel are unaware of it. Informing family members, caregivers, and emergency contacts is essential for ensuring that the order is honored.

  7. Assuming the DNR is automatically recognized: Some individuals mistakenly believe that a DNR order is automatically recognized in all settings. However, it is crucial to ensure that the order is valid and recognized by the specific healthcare providers involved.

Key takeaways

Understanding the Texas Do Not Resuscitate (DNR) Order form is crucial for making informed healthcare decisions. Here are key takeaways to consider:

  • The DNR Order form allows individuals to express their wishes regarding resuscitation efforts in case of cardiac or respiratory arrest.
  • It is essential to have the form signed by a physician to ensure its validity.
  • Patients or their legal representatives must provide consent for the DNR Order.
  • The form should be easily accessible to emergency medical personnel and healthcare providers.
  • Reviewing and updating the DNR Order regularly is important as health conditions may change.
  • Family members should be informed about the existence of the DNR Order to avoid confusion during emergencies.
  • The DNR Order does not affect other medical treatments; it only pertains to resuscitation efforts.
  • In Texas, the DNR Order is legally recognized and must be honored by all healthcare providers.
⇓ Do Not Resuscitate Order PDF

Steps to Using Texas Do Not Resuscitate Order

Completing the Texas Do Not Resuscitate Order form is an important step in ensuring that your healthcare preferences are respected in emergency situations. This form allows individuals to communicate their wishes regarding resuscitation efforts. Follow the steps below to fill out the form accurately.

  1. Obtain the Texas Do Not Resuscitate Order form. This can be found online or through healthcare providers.
  2. Read the instructions carefully to understand the requirements and implications of the form.
  3. Fill in your full name, date of birth, and contact information in the designated sections.
  4. Designate a healthcare agent if desired. This person will make decisions on your behalf if you are unable to do so.
  5. Indicate your wishes regarding resuscitation by checking the appropriate box. Options typically include "Do Not Resuscitate" or "Allow Resuscitation."
  6. Sign and date the form in the appropriate section to validate your wishes.
  7. Have the form witnessed by two adults who are not related to you and who will not benefit from your estate.
  8. Make copies of the completed form for your healthcare provider, your designated healthcare agent, and for your own records.

Once the form is completed and signed, it should be distributed to relevant parties to ensure that your wishes are known and can be honored. Keep the original in a safe place where it can be easily accessed when needed.