
Figure: 25 TAC 157.25 (h)(2) OUTOFHOSPITAL DONOTRESUSCITATE (OOH DNR) ORDER TEXAS DEPARTMENT OF STATE HEALTH SERVICES This document becomes effective immediately on the date of execution for health.
Open form follow the instructions
Easily sign the form with your finger
Send filled & signed form or save
How to fill out the TX EF01-11421 online
The TX EF01-11421, also known as the Out-of-Hospital Do-Not-Resuscitate (OOH-DNR) order, allows individuals to direct health care professionals not to initiate resuscitation efforts in out-of-hospital settings. This guide provides clear, step-by-step instructions for completing the form online, ensuring that you can navigate the process with ease and confidence.
Follow the steps to successfully complete the TX EF01-11421 form.
- Click the ‘Get Form’ button to obtain the TX EF01-11421 form and open it in your preferred online environment.
- Fill in the personal details of the individual for whom the DNR is being requested. This includes the person's full legal name, date of birth, and gender. Ensure that the information accurately reflects the individual's legal identification.
- In Section A, if the individual is competent and at least 18 years old, they should declare their wishes regarding resuscitation. The individual must sign and date this section, confirming their understanding and intent.
- In Section B, for individuals who are incompetent or unable to communicate, a legal guardian, agent, or proxy may sign on their behalf. They must indicate their relationship to the individual and provide their printed name and signature, along with the date.
- For Section C, if there is no guardian or proxy, a qualified relative may complete this section. They must identify their relationship to the individual and provide their signature, printed name, and date.
- If applicable, Section D allows the attending physician to execute the order based on prior directives or nonwritten communication from the competent individual. The physician must also sign and date this section.
- In Section E, for minors diagnosed with a terminal condition, a parent, legal guardian, or conservator must complete this section and provide their signature, printed name, and date.
- Section F is for use by physicians with concurrence from a second physician if the individual is incompetent and has no representatives available. Both physicians must sign and date this section.
- Two witnesses must review the document's signing process and confirm their presence by signing in the designated areas. Include their printed names and dates next to their signatures.
- Optionally, you may have the document notarized. A notary public can provide a signature and seal, but they cannot acknowledge witnessing a nonwritten communication.
- After completing all applicable sections, ensure that you save your changes. You can then download, print, or share the form as necessary, ensuring you retain a copy for your records.
Start completing your TX EF01-11421 online today to ensure your healthcare preferences are respected.
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Related content
Report problems with this form to the Texas Department of State Health Services (DSHS) or...
Report problems with this form to the Texas Department of State Health Services (DSHS) or...
Get answers to your most pressing questions about US Legal Forms API.
What is needed for a DNR order to be valid?
Regardless of the format or the venue, DNR orders almost always follow the same general rules to be valid: DNR orders must be written by medical professionals rather than verbalized. ... Written DNR orders must include the patient's name. ... DNR orders must be dated. ... The DNR order must be signed by the healthcare provider.
Who can witness a DNR in Texas?
Qualified Witnesses: Both witnesses must be competent adults, who have witnessed the competent adult person making his/her signature in section A, or person's authorized representatives making his/her signature in either Sections B, C, or E on the OOH-DNR Order, or if applicable, have witnessed the competent adult ...
What are the different types of DNR?
There are currently two types of DNR orders: 1) "DNR Comfort Care," and 2) "DNR Comfort Care - Arrest." Upon the issuance of either order, standard forms of identification are provided for in OAC rule 3701-62-04.
Does a Texas OOH DNR have to be notarized?
Have the witnesses sign and date this and attach it to the DNR form. 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.
What makes a DNR valid in Texas?
(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 ...
What does do not resuscitate order mean?
To use the sharing features on this page, please enable JavaScript. A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating.
What is a standard out-of-hospital do not resuscitate order in Texas?
With a Texas Out-of-Hospital DNR order, emergency medical professionals cannot start or continue: cardiopulmonary resuscitation (CPR: chest compressions and airway) advanced airway management (clearing the airway, usually with a breathing tube) artificial ventilation (machine or procedure to restore breathing)
What do you need for an out-of-hospital DNR in Texas?
What is required for an Out-of-Hospital DNR? 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.
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
If you believe that this page should be taken down, please follow our DMCA take down process here.