Fill Out Your Document

Blank Do Not Resuscitate Order Form for California State

A California Do Not Resuscitate Order (DNR) form allows individuals to express their wishes regarding medical treatment in the event of a life-threatening situation. This legal document ensures that healthcare providers respect a person's desire to forgo resuscitation efforts. Understanding how to properly fill out this form is crucial for anyone wanting to make their healthcare preferences known.

Take control of your healthcare decisions today by filling out the DNR form. Click the button below to get started!

Fill Out Your Document

Table of Contents

Document Overview

Fact Name	Details
Definition	A Do Not Resuscitate (DNR) Order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.
Governing Law	The California DNR Order is governed by the California Health and Safety Code, Section 7180-7190.
Eligibility	Any adult 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 legal representative, along with a physician's signature.
Form Availability	The California DNR Order form is available through various 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.
Emergency Medical Services	Emergency medical personnel must honor a valid DNR Order when presented during an emergency.
Durability	The DNR Order remains in effect until revoked or until the patient’s condition changes significantly.

Download Do Not Resuscitate Order PDF Form

Discover More Do Not Resuscitate Order Templates for Specific States

What Is Dnr Mean - A DNR underscores the importance of discussing health care wishes with loved ones.

Dnr Comfort Care - Captures a patient's intentions in case their health deteriorates unexpectedly.

Dnr and Dni Documents Are All Part of What Are Known as - Complete a Do Not Resuscitate Order to avoid unwanted interventions when facing terminal health conditions.

How to Get a Dnr Bracelet - A DNR is specifically focused on avoiding invasive life-saving measures when they are not desired.

Documents used along the form

When considering end-of-life care and medical decisions, individuals may encounter various documents that complement the California Do Not Resuscitate (DNR) Order form. Each of these documents serves a unique purpose in ensuring that a person's medical preferences are honored. Below is a list of commonly used forms and documents that often accompany a DNR order.

Advance Healthcare Directive: This document allows individuals to outline their healthcare preferences and appoint a trusted person to make medical decisions on their behalf if they become unable to do so.
Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that specifies which life-sustaining treatments a patient wishes to receive or not receive, based on their current health status.
Living Will: A living will is a legal document that communicates a person's wishes regarding medical treatment in situations where they are unable to express their desires, particularly in terminal or irreversible conditions.
Durable Power of Attorney for Healthcare: This document designates an individual to make healthcare decisions on behalf of someone else, ensuring that their preferences are respected when they cannot speak for themselves.
Do Not Intubate (DNI) Order: Similar to a DNR, a DNI order specifically instructs medical personnel not to insert a breathing tube if the patient is unable to breathe on their own.
Medical Release Form: This form allows healthcare providers to share a patient’s medical information with designated individuals, facilitating communication among family members and caregivers.
Organ Donation Consent Form: This document expresses a person’s wishes regarding organ donation after death, providing important information for healthcare providers and family members.
Funeral Planning Documents: These documents outline preferences for funeral arrangements, including burial or cremation wishes, helping to ease the burden on family members during a difficult time.
Patient Advocate Designation: This form allows individuals to appoint a patient advocate who can help ensure their medical wishes are followed and that they receive appropriate care.

Understanding these documents can empower individuals to make informed decisions about their healthcare and end-of-life preferences. By preparing these forms in advance, one can ensure that their wishes are respected and that their loved ones are not left to navigate difficult decisions during emotional times.

Document Sample

California Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order (DNR) is executed in accordance with California Probate Code, Section 4780 et seq. It is intended to convey the wishes of the individual regarding resuscitation efforts in the event of cardiac or respiratory arrest.

Patient Information

Patient's Full Name: _______________________________________
Date of Birth: ____________________________________________
Patient's Address: _______________________________________

Authorization

I, the undersigned, hereby state that I am of sound mind and am making this decision regarding my medical treatment.

In the event that my heart stops beating or I stop breathing, I do not want any resuscitation attempts, including but not limited to:

Cardiopulmonary resuscitation (CPR)
Intubation
Defibrillation

Patient's Signature: ________________________________________

Date: ________________________________________________

Health Care Provider Information

Health Care Provider's Name: ____________________________
Health Care Provider's Address: _________________________
Health Care Provider's Phone Number: ____________________

Witness Information

This DNR must be witnessed by one adult who is not related to the patient.

Witness Name: __________________________________________
Witness Signature: _____________________________________
Date: ________________________________________________

Important Note: This order should be placed in a prominent location where emergency personnel can easily find it. A copy of this document should also be shared with family members and your healthcare provider.