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.
San Diego California Do Not Resuscitate Request - DNR
State:
Multi-State
County:
San Diego
Control #:
US-PRM-12
Format:
Word;
Rich Text
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How to fill out Do Not Resuscitate Request - DNR?
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FAQ
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.
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.
An adult patient may consent to a DNR order orally by informing a physician, or in writing, such as a living will, if two witnesses are present. In addition, the Health Care Proxy Law allows you to appoint someone you trust to make decisions about CPR and other treatments if you become unable to decide for yourself.
A DNR is a request not to have CPR if your heart stops or if you stop breathing. You can use an advance directive form or tell your doctor that you don't want to be resuscitated. Your doctor will put the DNR order in your medical chart. Doctors and hospitals in all states accept DNR orders.
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).
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
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.
The Prehospital Do Not Resuscitate (DNR) Form has been developed by the California Emergency Medical Services Authority, in concert with the California Medical Association and emergency medical services (EMS) providers, for the purpose of instructing EMS personnel regarding a patient's decision to forego resuscitative
How Do You Get A Do Not Resuscitate Order? If you decide you wish to have a DNR order put in place, inform your doctor. Your doctor is required to follow your wishes or transfer your care to a physician who is willing to carry them out. The doctor will fill out a form for a DNR order and add it to your medical record.
