Dnr Form Blank For Texas

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State:
Multi-State
Control #:
US-02091BG
Format:
Word; 
Rich Text
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Description

A do not resuscitate (DNR) order is a request not to have cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. Unless given other instructions, hospital staff will try to help all patients whose heart has stopped or who have stopped breathing. A DNR order is put in your medical chart by your doctor. DNR orders are accepted by doctors and hospitals in all states.


This form is a generic example that may be referred to when preparing such a form for your particular state. It is for illustrative purposes only. Local laws should be consulted to determine any specific requirements for such a form in a particular jurisdiction.

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  • Preview Do Not Resuscitate Order - DNR or Advance Directive

How to fill out Do Not Resuscitate Order - DNR Or Advance Directive?

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FAQ

Does the form have to be notarized? A notary public can witness the signature of the person filling out the form in lieu of two witnesses. If two witnesses are present, the form does not need to be notarized.

The Texas Out-of-Hospital DNR form requires your signature, the signatures of your doctor, and the signatures of two competent adult witnesses or a notary instead of the witnesses. If you use two witnesses, rather than a notary, one of the two witnesses cannot be: Your relative (by blood or marriage)

It just includes the patient's name, date of birth, a statement indicating, ?do not resuscitate the person named above,? and then signatures and information for the physician, nurse practitioner, or physician assistant completing the form. The form must be signed by a medical provider, as it is a medical order.

(1) An intact, unaltered, easily identifiable plastic identification OOH DNR bracelet, with the word "Texas" (or a representation of the geographical shape of Texas and the word "STOP" imposed over the shape) and the words "Do Not Resuscitate," shall be honored by qualified EMS personnel in lieu of an original OOH DNR ...

The DNR must be signed by the patient or by the patient's legally recognized health care decision maker if the patient is unable to make or communicate informed health care decisions.

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Dnr Form Blank For Texas