California Prehospital Do Not Resuscitate
What this document covers
The California Prehospital Do Not Resuscitate (DNR) Form is a legal document that instructs emergency medical services (EMS) personnel not to perform resuscitation efforts if a patient experiences a cardiac or respiratory arrest. This form specifically outlines the medical procedures to be withheld, ensuring that a patientâs preferences are respected during critical moments. Unlike standard medical directives, it is tailored for use in prehospital settings, such as at home or in long-term care facilities, and empowers patients to make informed decisions about their end-of-life care.
Key parts of this document
- Patient identification section for entering the patientâs name.
- Consent acknowledgment confirming the patient's understanding of the DNR directive.
- Signature lines for both the patient or surrogate decision-maker and the attending physician.
- Information on the revocation process for the DNR order.
- Instruction for maintaining the form and optional medallion for easy identification.
When to use this document
This form should be utilized in situations where a patient wishes to forego resuscitative measures in the event of cardiac or respiratory failure. It is essential for patients with terminal conditions or those who, after careful consideration, decide that they do not want aggressive resuscitation. It is also appropriate for individuals nearing the end of life who want to ensure their wishes regarding emergency medical care are clearly communicated to healthcare providers.
Who can use this document
- Patients diagnosed with terminal illnesses who wish to limit aggressive medical interventions.
- Individuals seeking to communicate their end-of-life preferences clearly to emergency medical responders.
- Surrogate decision-makers acting on behalf of patients unable to make healthcare decisions.
Steps to complete this form
- Print the patient's full name in the designated area.
- Have the patient or surrogate sign the form, acknowledging their understanding of the DNR provisions.
- Ensure the patientâs physician also signs, confirming informed consent has been given.
- Retain the first copy for the patientâs records and provide the second copy to the physician for the patient's medical record.
- If applicable, complete the section for ordering an optional DNR medallion for easier identification by EMS personnel.
Is notarization required?
This form does not typically require notarization unless specified by local law. Ensure the form is signed by the necessary parties for it to be valid.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Typical mistakes to avoid
- Failing to sign the form, which renders it invalid.
- Not providing a copy to the physician for the medical record.
- Not ensuring the form is readily accessible to emergency responders.
- Confusing this DNR form with other types of advance directives.
Why use this form online
- Convenience: Easily fill out and download the form from your home.
- Editability: Customize the form to reflect your specific wishes before printing.
- Reliable source: Access documents created by licensed attorneys, ensuring legal validity.
Key takeaways
- The California Prehospital DNR Form allows patients to express their wish not to receive resuscitation in emergencies.
- It is essential to complete and present this form to ensure emergency medical services honor the patient's wishes.
- The form must be signed by both the patient (or surrogate) and the physician to be valid.
