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Blank Do Not Resuscitate Order Form for Texas State

A Texas Do Not Resuscitate (DNR) Order form is a legal document that allows individuals to express their wishes regarding medical treatment in the event of a life-threatening situation. By completing this form, patients can ensure that they receive care aligned with their personal values and preferences. Understanding the significance of this document is crucial for anyone considering their end-of-life choices.

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Table of Contents

Document Overview

Fact Name	Description
Definition	A Texas Do Not Resuscitate (DNR) Order is a legal document that informs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a patient's heart stops or they stop breathing.
Governing Law	The Texas DNR Order is governed by the Texas Health and Safety Code, Chapter 166, which outlines the legal framework for advance directives.
Eligibility	Any adult who is capable of making their own medical decisions can complete a DNR Order. This includes individuals who are terminally ill or have a serious medical condition.
Form Requirements	The DNR Order must be signed by the patient or their legally authorized representative and a physician. It must also be in writing to be valid.
Emergency Medical Services	Emergency medical personnel are required to honor a valid Texas DNR Order. This ensures that the patient's wishes are respected in emergencies.
Revocation	A DNR Order can be revoked at any time by the patient or their representative. This can be done verbally or in writing.
Storage and Accessibility	It is important to keep the DNR Order in an easily accessible location. Patients should carry a copy with them, especially when visiting hospitals or emergency services.
Additional Considerations	Patients may also consider other advance directives, such as a living will or medical power of attorney, to further clarify their medical care preferences.

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Discover More Do Not Resuscitate Order Templates for Specific States

Dnro - The document must be signed by the patient and may also require a witness or physician’s signature, depending on state laws.

Georgia Do Not Resuscitate Form - Validated samples often available to aid in understanding its implementation.

Dnr Comfort Care - A directive that serves to honor a patient's end-of-life preferences regarding resuscitation.

Polst Form Washington State - Encourages thoughtful reflection on what quality of life means to the patient.

Documents used along the form

The Texas Do Not Resuscitate (DNR) Order form is an important document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. Along with the DNR, several other forms and documents may be used to ensure that a person's healthcare preferences are clearly communicated and respected. Here’s a list of related documents that can complement the DNR Order.

Advance Directive: This document outlines a person's preferences for medical treatment and care in situations where they cannot communicate their wishes. It often includes decisions about life-sustaining treatments.
Medical Power of Attorney: This form designates an individual to make healthcare decisions on behalf of someone else if they become unable to do so. It ensures that someone trusted can advocate for the person’s medical preferences.
Living Will: A living will specifies 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 outlines a patient's preferences for life-sustaining treatments. It is intended for individuals with serious illnesses or frailty.
Do Not Intubate (DNI) Order: Similar to a DNR, a DNI order specifically instructs healthcare providers not to insert a breathing tube in the event of respiratory failure.
Healthcare Proxy: This document allows a person to appoint someone to make healthcare decisions on their behalf, similar to a medical power of attorney but often more focused on specific healthcare choices.
Organ Donation Registration: This form indicates a person's wishes regarding organ donation after death. It can be registered through various state agencies or organizations.
Patient Advocate Form: This document designates an individual to advocate for a patient's wishes and needs within the healthcare system, ensuring that their preferences are respected.

Each of these documents plays a crucial role in ensuring that an individual's healthcare preferences are honored. By having these forms in place, individuals can provide clear guidance to their families and healthcare providers, ultimately leading to better alignment with their values and wishes during critical times.

Document Sample

Texas Do Not Resuscitate (DNR) Order Template

This Do Not Resuscitate Order (DNR) is created in accordance with Texas Health and Safety Code Section 166.202. It is intended to communicate the wishes regarding emergency medical treatment in the event of cardiac or respiratory arrest.

Patient Information:

Full Name: ____________________________
Date of Birth: ____________________________
Address: ______________________________
City, State, Zip Code: ______________________________

Physician Information:

Physician's Name: ____________________________
Phone Number: ____________________________
Medical License Number: ____________________________

Emergency Contact Information:

Name: ____________________________
Relationship: ____________________________
Phone Number: ____________________________

Patient Directive:

I, the undersigned, express my preference regarding the provision of cardiopulmonary resuscitation (CPR). I do not wish to receive CPR or any other resuscitation attempts in the event of cardiac or respiratory arrest.

Signature of Patient or Legal Representative: ____________________________

Date: ____________________________

Witness Information:

Witness Name: ____________________________
Signature: ____________________________
Date: ____________________________

This DNR order should accompany the patient’s medical records and be accessible to all healthcare providers involved in the patient’s care.