This is a form initiated by a patient requesting that he/she not be resuscitated should he/she stop breathing or should his/her heart stop beating. This form is also to be signed by a physician attesting to patient's wishes and to be placed in the patient's file.
Sacramento California Do Not Resuscitate Request - DNR
State:
Multi-State
County:
Sacramento
Control #:
US-PRM-12
Format:
Word;
Rich Text
Instant download
Description
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How to fill out Do Not Resuscitate Request - DNR?
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FAQ
The most important factor to bear in mind is that the law does not require a patient, or their family to consent to a DNR order. This means a doctor can issue a DNR order, even if you do not want one (see section on what to do if there is a disagreement).
You may download the form or call us at (916) 322-4336 to have the form mailed to you. If you wish to obtain a large supply, you should contact the CMA publications office directly, at 1(800) 882-1262 or the California Medical Association website. DNR Form (doc) , (pdf).
The DNR form should be clearly posted or maintained near the patient. You may download the form or call us at (916) 322-4336 to have the form mailed to you. If you wish to obtain a large supply, you should contact the CMA publications office directly, at 1(800) 882-1262 or the California Medical Association website.
Establish the setting. Ensure comfort and privacy; sit down next to the patient. Ask if family members or others should be present. Introduce the subject with a phrase such as: I'd like to talk with you about possible health care decisions in the future.
In summary, the minimum requirement in order for a DNR form to be valid is the valid signature and date of the patient, or of their legally recognized healthcare agent in the event that they are incapacitated or otherwise unable to express their wishes. Second, the form must be signed off by the attending physician.
The attending physician/provider must provide the DNR/DNAR order, either in writing or verbally. A verbal DNR/DNAR order may be taken by a licensed nurse and co-signed by the physician/provider within 24 hours. Agreed to by the designated healthcare agent(s), for a patient without decision-making capacity.
The California do not resuscitate order form (DNR) is a document that, when signed by a patient and their physician, will prevent EMTs, paramedics, and other emergency personnel from performing any medical procedures on an individual if their heart stops beating or they stop breathing.
A DNR order must be written by a doctor. The doctor will typically explain your options to you and your family, outlining what the DNR entails. With your consent, the doctor will create the order and enter it into your medical record. It will then be visible and applicable to any medical professionals who treat you.
If an individual is incapacitated, then health care professionals and emergency responders will pursue all potentially life-sustaining treatments in the event of a medical crisis unless a valid order written by a physician (like a DNR) is presented.
However, hospitals are encouraged to honor the form when a patient is transported to an emergency room. California law protects any health care provider (including emergency response personnel) who honors a properly completed request regarding resuscitative measures, including a Prehospital Do Not Resuscitate Form (or
