Blank Do Not Resuscitate Order Template for the State of Texas

Guidelines on Utilizing Texas Do Not Resuscitate Order

Filling out a Texas Do Not Resuscitate (DNR) Order form is an important step for individuals wishing to make their healthcare preferences known in advance, specifically regarding the choice not to receive cardiopulmonary resuscitation (CPR) in the event of a cardiac or respiratory arrest. This document is crucial for communicating these wishes to healthcare providers and ensuring that they are respected. Here's a straightforward guide to completing the Texas DNR Order form accurately.

1. Ensure you have the correct and most current version of the Texas DNR Order form by visiting the Texas Department of State Health Services website.
2. Read the entire form carefully before filling it out to understand all the sections and instructions clearly.
3. Complete the "Patient Information" section with the full legal name, date of birth, and address of the individual the DNR Order is for.
4. If the individual completing the form is not the patient, fill in the "Surrogate Decision Maker" section with your name, relation to the patient, and the basis for your authority to make decisions on behalf of the patient.
5. In the "Physician Information" section, enter the full name, address, and contact details of the physician who is completing and signing the form.
6. Review the "DNR Order" section with the physician to ensure it reflects the patient’s wishes accurately. The physician should then sign and date the form in this section.
7. The form requires a witness signature in the designated "Witness" section. This can be anyone present who is 18 years or older, excluding the patient. Have this section signed and dated by the witness.
8. Some circumstances allow for an alternate witness or verbal confirmation. If applicable, ensure the "Out-of-Hospital DNR Order Verification" part is completed correctly.
9. Once completed, make several copies of the DNR Order. Provide a copy to the patient or keep it in an easily accessible place, give one to the designated physician, and consider giving copies to close family members or caregivers.
10. Review and update the DNR Order as needed, especially if the patient’s healthcare situation or preferences change.

Completing the Texas DNR Order form is a straightforward but profound decision to ensure that an individual’s end-of-life wishes are respected. By following these steps carefully, one can make sure the process is done correctly. Always consult with healthcare providers or a legal professional if you have questions or need guidance throughout this process.

1. What is a Texas Do Not Resuscitate Order (DNR) form?

   A Texas Do Not Resuscitate (DNR) Order form is a legal document that tells health care providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating. It's used by individuals who wish to avoid life-prolonging measures in these situations.

2. Who can request a DNR order in Texas?

   In Texas, a DNR order can be requested by adult patients who are competent to make their own medical decisions, legally authorized representatives for patients who are unable to make their own medical decisions, or by a parent or legal guardian if the patient is a minor.

3. How can someone obtain a Texas DNR order?

   Obtaining a Texas DNR order involves a discussion with a healthcare provider. The healthcare provider will review the patient's medical condition and explain the implications and consequences of a DNR order. If the patient decides to proceed, the healthcare provider will prepare the DNR order, which must be signed by the patient (or their representative) and the provider.

4. Where is a Texas DNR order applicable?

   A Texas DNR order is applicable in various settings, including hospitals, nursing homes, assisted living facilities, and at the patient's home. Emergency medical services (EMS) personnel are also required to comply with DNR orders when they are made aware of the order's existence and can verify its authenticity.

5. Does the family have a say in activating a DNR order?

   Generally, if a patient has competently made a decision to have a DNR order, and it aligns with Texas laws, health care providers are bound to follow it, even if the family disagrees. However, if a patient is unable to make decisions, and a family member is the legally authorized representative, that representative has the authority to request or cancel a DNR order on behalf of the patient.

6. Can a Texas DNR order be revoked or canceled?

   Yes, a Texas DNR order can be revoked at any time by the patient or their legally authorized representative. This can be done by informing the healthcare provider orally or in writing. Destroying the DNR order document is another effective way to revoke it. However, it is advisable to communicate this decision to any and all healthcare providers involved in the patient's care.

7. What is the difference between a DNR order and a living will?

   A DNR order is specifically about not receiving CPR if your heart stops or if you stop breathing. A living will, on the other hand, is a broader document that describes your wishes regarding other types of medical treatments and life-prolonging measures should you become unable to make your own decisions. Both are forms of advance directives but serve different purposes.

8. Is a Texas DNR order valid in other states?

   DNR orders, including those from Texas, may not be automatically recognized in other states due to varying laws and regulations. If you travel or move to another state, it's recommended to speak with a healthcare provider or a legal expert about transferring your DNR order or creating a new one that complies with local laws.

9. How does one ensure their Texas DNR order is followed?

   To ensure a Texas DNR order is followed, keep it in a visibly accessible place if you're at home or inform healthcare providers of its existence when receiving care. For those at home, notifying family members and close contacts about the DNR order and its location is crucial. Additionally, wearing a DNR bracelet can alert emergency personnel to the existence of a DNR order.

Filling out a Texas Do Not Resuscitate (DNR) Order requires attention to detail and accuracy. People often make mistakes during this sensitive process. Understanding these common errors can help you avoid them.

1. Not verifying the patient's identity correctly: It's crucial to ensure the name, date of birth, and other personal details match the patient's official documentation exactly.

2. Skipping the witness or patient representative section: Every DNR form needs a witness or, if applicable, a legal patient representative’s signature for validation. Failing to include this can invalidate the document.

3. Misunderstanding the form’s scope: Some people think this document covers more than it actually does. This form specifically relates to not performing cardiopulmonary resuscitation (CPR) in the event the patient's breathing or heart stops.

4. Using an unofficial form: Always ensure you're using the official, most current version of the Texas DNR Order form. Using outdated or unofficial forms can lead to processing delays or outright rejection.

5. Incorrect or unclear physician information: The form requires the attending physician's details, including a signature. Incorrect information or a missing signature can lead to the form not being honored.

6. Not discussing the decision with family members: While not a requirement for the form's validity, failing to inform family members of the DNR order can cause confusion and distress during critical moments.

7. Forgetting to review and update the form: Circumstances and decisions can change. Regularly reviewing and updating the DNR order ensures it reflects the current wishes of the patient.

Correcting these mistakes helps ensure that the patient's wishes are respected and that the document is legally binding and effective when needed.

In Texas, the Do Not Resuscitate (DNR) Order form is a critical document for those who wish to refuse certain life-sustaining treatments in the event of cardiac or respiratory arrest. However, to ensure comprehensive healthcare planning, this form is often accompanied by other legal documents that express the individual's wishes regarding medical treatment and end-of-life care. These forms, when used together, can provide a clearer understanding of a person's healthcare preferences and ensure they are honored.

• Medical Power of Attorney (MPOA): This document grants an individual the authority to make healthcare decisions on behalf of the person if they become unable to make decisions for themselves. Unlike the DNR Order, which is specific to resuscitation, the MPOA covers a broad range of medical decisions.
• Directive to Physicians and Family or Surrogates: Often referred to as a Living Will, this document outlines the person's wishes regarding the use of life-sustaining treatment if they are terminally ill or irreversibly unconscious and unable to make decisions for themselves.
• Out-of-Hospital Do Not Resuscitate (OOH-DNR) Order: Specifically designed for situations that occur outside of a hospital setting, this order informs emergency medical professionals not to initiate resuscitation efforts in the event of cardiac or respiratory failure.
• Declaration for Mental Health Treatment: This form allows individuals to make decisions about their mental health treatment in advance, including consent or refusal of specific types of mental health treatments, should they later be deemed incapable of making these decisions themselves.
• HIPAA Release Form: The Health Insurance Portability and Accountability Act (HIPAA) release form allows healthcare providers to share a patient’s health information with designated individuals, facilitating better communication among caregivers and loved ones regarding treatment and healthcare preferences.
• Physician Orders for Scope of Treatment (POST): Similar to a DNR, the POST form is a physician’s order that outlines a wide range of treatment preferences, including resuscitation, antibiotics, and artificial nutrition. It is typically used by individuals with serious illness or frailty near the end of life.

Together, these documents form a comprehensive legal framework that respects the healthcare preferences of the individual, ensuring that their wishes are clearly communicated and respected by family, healthcare providers, and legal authorities. Each document plays a unique role in safeguarding the autonomy of individuals in making informed decisions about their health care and end-of-life care. It's essential for individuals, especially those with severe or terminal illnesses, to understand these documents and consider which ones best suit their needs and preferences.

• Living Will: A Living Will, much like a Do Not Resuscitate (DNR) Order, is a legal document that communicates a person's wishes regarding life-sustaining treatments in the event they are unable to communicate due to illness or incapacity. Both documents are proactive measures to control medical care preferences, ensuring that treatments align with the individual's values and desires.

• Healthcare Power of Attorney: This document is akin to a DNR in that it allows an individual to designate another person, known as a healthcare proxy, to make medical decisions on their behalf should they become incapacitated. While a DNR specifically addresses the use of resuscitation efforts, a Healthcare Power of Attorney covers a broader range of medical decisions, including the enforcement of a DNR.

• Advance Directive: An Advance Directive is an umbrella term that encompasses both Living Wills and DNR Orders. It is designed to lay out an individual's preferences for end-of-life care and medical treatments. Advance Directives ensure that a person's medical care preferences are known and respected, even when they cannot voice these preferences themselves.

• Medical Orders for Life-Sustaining Treatment (MOLST) or Physician Orders for Life-Sustaining Treatment (POLST): Both MOLST and POLST forms are physician's orders that specify the types of medical treatment that a patient wishes to receive towards the end of life, including resuscitation preferences. They are similar to DNR orders but are more comprehensive, covering other treatments beyond resuscitation.

• Organ Donor Registration: Though primarily focused on the donation of organs and tissues after death, an Organ Donor Registration form shares the common theme of making one's medical-related wishes known in advance. Like a DNR, it is a directive that takes effect after the individual is unable to make or communicate decisions, ensuring that their final wishes are honored.

When approaching the process of filling out the Texas Do Not Resuscitate (DNR) Order form, it's crucial to keep in mind a list of key practices to ensure the document is completed accurately and effectively. Here is a guide divided into what you should and shouldn't do:

What You Should Do

1. Ensure Accuracy: Double-check all entered information to make sure it is accurate. Mistakes could lead to misinterpretation of the patient's wishes.
2. Consult with a Healthcare Professional: Before completing the form, it’s important to have a thorough discussion with a healthcare provider to understand the implications of a DNR order fully.
3. Use Legible Handwriting: If the form is filled out by hand, make sure that all entries are legible to everyone who might need to read the form.
4. Keep it Accessible: After completing the form, keep it in a place where it can be easily found by family members and healthcare providers.

What You Shouldn’t Do

1. Do Not Leave Blank Spaces: Avoid leaving any section of the form blank. If a specific part does not apply, write "N/A" (Not Applicable) instead of leaving it empty.
2. Avoid Legal Jargon: Unless specifically required, there’s no need to use legal terminology. The aim is for the document to be understood by all parties involved.
3. Do Not Forget to Sign and Date: The form typically requires a signature from the patient (or legal representative) and a witness or healthcare provider. Omitting these signatures may invalidate the form.
4. Do Not Delay Submission: Once completed, promptly submit the form to the appropriate healthcare facility or provider to ensure it is entered into the patient's medical record.

When it comes to understanding the Texas Do Not Resuscitate (DNR) Order form, several misconceptions can lead individuals and their families to make decisions based on incomplete or inaccurate information. It's crucial to clear up these misunderstandings to ensure that individuals' wishes concerning medical treatment are respected. Here are nine common misconceptions about the Texas DNR Order form:

• Only the elderly or terminally ill can have a DNR order. People often believe that DNR orders are exclusively for older adults or those at the end of their lives. However, a person of any age with serious health conditions may consider a DNR order if they do not wish to receive CPR in the event of cardiac or respiratory arrest.

• A DNR order affects all medical treatment. Some might think that a DNR order means no medical treatments will be provided. In reality, it specifically instructs healthcare professionals not to perform CPR. Other treatments, such as pain relief, antibiotics, or nutrition, can still be given based on the patient's wishes and the medical team's judgment.

• Doctors decide when to implement a DNR order. There is a common misconception that doctors unilaterally decide to place a DNR order without involving the patient or their family. In truth, a DNR order is only implemented with the consent of the patient or, if the patient is unable to make decisions, the patient's legally authorized representative.

• DNR orders are permanent and cannot be changed. Many believe once a DNR order is placed, it is permanent. However, a DNR order can be rescinded or altered at any time by the patient or their designated decision-maker if the patient's health status or personal wishes change.

• You need a lawyer to complete a DNR form. While it's important to consult with healthcare professionals and potentially discuss your wishes with legal counsel, the process of completing a DNR order in Texas does not require a lawyer. The patient, or their authorized representative, can complete the form with assistance from healthcare staff.

• A DNR order must be notarized to be valid. Unlike some other legal documents, the Texas DNR Order form does not need to be notarized. It must be signed by the patient (or their representative) and the physician to be valid.

• DNR orders are only effective in hospitals. A common misconception is that DNR orders are only recognized and effective in hospital settings. In Texas, DNR orders are also valid in other healthcare settings, such as nursing homes, and during transport by emergency medical services (EMS).

• Emergency responders will not provide any assistance if they see a DNR order. Some people worry that if emergency personnel know there is a DNR order, they will not provide any care. However, emergency responders can offer comfort care and support vital functions. They can manage pain, bleeding, or respiratory distress, following the limits of the DNR order regarding CPR.

• Having a DNR means you will receive a lower standard of care. There is a concern that a DNR order might influence the overall care a patient receives, leading to a reduction in the quality or extent of care. Healthcare professionals are ethically bound to provide the same standard of care to all patients, regardless of their DNR status. A DNR order only affects the use of CPR, not other medical treatments or interventions.

Understanding these misconceptions can help individuals and their families make informed decisions regarding DNR orders, ensuring their healthcare preferences are respected.

Filling out and using the Texas Do Not Resuscitate (DNR) Order form is a critical process for those wishing to document their preferences regarding life-sustaining measures. There are several essential points to keep in mind:

• Understanding the purpose: A Texas DNR form is a legal document that tells health care professionals not to perform cardiopulmonary resuscitation (CPR) if a person's breathing or heartbeat stops. This document is crucial for individuals who wish to decline life-sustaining treatments in specific circumstances.
• Eligibility and consent: The individual completing the form must have the capacity to make their own medical decisions or have a legally authorized person act on their behalf. It's essential to ensure that the form reflects the person's wishes accurately and is filled out with informed consent.
• Proper completion and documentation: Completing the form accurately and following all Texas state guidelines is necessary for the DNR order to be valid. This often includes having the form signed by a physician and ensuring it is readily accessible to health care providers.
• Making it accessible: Once completed and signed, the Texas DNR form should be kept in a place where it can be easily found by family members and healthcare providers. Some individuals choose to inform their primary care physician, keep a copy at home in a noticeable location, or carry a wallet card indicating they have a DNR order.

It's recommended to discuss the decision to complete a DNR form with family members, healthcare providers, and, if applicable, a legal advisor to ensure all are aware of the individual's wishes and the document's legal implications. Acknowledging these key points can ensure the process honors the person's healthcare preferences accurately and respectfully.