Get Tx Ef01-11421 2009-2025

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.

1. Click the ‘Get Form’ button to obtain the TX EF01-11421 form and open it in your preferred online environment.
2. 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.
3. 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.
4. 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.
5. 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.
6. 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.
7. 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.
8. 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.
9. 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.
10. Optionally, you may have the document notarized. A notary public can provide a signature and seal, but they cannot acknowledge witnessing a nonwritten communication.
11. 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.