Official Texas Do Not Resuscitate Order Document Get Do Not Resuscitate Order Here

Official Texas Do Not Resuscitate Order Document

A Texas Do Not Resuscitate Order (DNR) form is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. By completing this form, a person can indicate that they do not want life-saving measures, such as cardiopulmonary resuscitation (CPR), to be performed. Understanding the implications of this form is crucial for ensuring that one's healthcare preferences are respected in critical situations.

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In Texas, the Do Not Resuscitate (DNR) Order form serves as a critical document for individuals wishing to express their preferences regarding medical interventions in the event of a cardiac arrest or respiratory failure. This form allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining treatments when they are unable to speak for themselves. It is essential for ensuring that healthcare providers respect a patient’s wishes during emergencies. The DNR form must be completed and signed by a physician and the patient or their legal representative, making it a legally binding directive. Additionally, it is important to note that this form should be readily available and easily identifiable, as medical personnel must be able to locate it quickly in critical situations. Understanding the implications and requirements of the Texas DNR Order form can empower individuals to make informed decisions about their healthcare and end-of-life preferences.

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Texas Do Not Resuscitate (DNR) Order Template

This document serves as a Texas Do Not Resuscitate (DNR) Order, in accordance with the Texas Advance Directives Act. It indicates the decision of the individual named herein, or their authorized legal representative, to forgo resuscitation attempts in the event of cardiac or respiratory arrest. Please complete all sections with the appropriate information.

Section 1: Patient Information

  • Full Name: ___________________________
  • Date of Birth: ________________________
  • Address: ______________________________
  • City: ______________________ State: TX Zip Code: _________
  • Primary Phone: _________________________

Section 2: Legal Representative Information (if applicable)

  • Full Name: ___________________________
  • Relationship to Patient: ________________
  • Address: ______________________________
  • City: ______________________ State: TX Zip Code: _________
  • Primary Phone: _________________________

Section 3: DNR Agreement

I, ________________________ (Patient/Legal Representative), hereby request and consent to the issuance of a Do Not Resuscitate Order, as defined under the Texas Health and Safety Code, Chapter 166. I understand that this order will direct health care professionals not to initiate cardiopulmonary resuscitation (CPR) in the event of my cardiac or respiratory arrest.

This decision is made after careful consideration. I understand the full implications of this order, including that health care providers will not undertake resuscitation efforts should I experience a cardiac or respiratory arrest.

Section 4: Signature

By signing below, I affirm that I am fully informed and voluntarily make this decision regarding resuscitation measures.

  • Patient/Legal Representative Signature: __________________ Date: ____________
  • Physician Signature: _______________________________ Date: ____________
  • Witness (if required): ______________________________ Date: ____________

Instructions for Filing: This document must be printed and signed by the necessary parties. Once completed and signed, it should be placed in a prominent location and provided to the patient's physician and health care facility where the patient receives care.

Notice: This document does not replace the need for an advance health care directive or living will. For comprehensive planning, please consult with a legal professional or health care provider.

Form Information

Fact Name Description
Definition The Texas Do Not Resuscitate (DNR) Order form allows individuals to refuse resuscitation efforts in the event of a medical emergency.
Governing Law This form is governed by the Texas Health and Safety Code, specifically Chapter 166, which outlines advance directives.
Eligibility Any adult who is capable of making their own medical decisions can complete a DNR order.
Signature Requirements The form must be signed by the individual or their legal representative, and it requires the signature of a physician.
Placement It is essential to keep the DNR order visible, such as on the refrigerator or in a medical alert bracelet, to ensure emergency personnel can easily find it.
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