Official  Do Not Resuscitate Order Form for California

Official Do Not Resuscitate Order Form for California

A California Do Not Resuscitate (DNR) Order 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, patients can ensure that their preferences for end-of-life care are respected, providing peace of mind for both themselves and their loved ones. To take control of your healthcare decisions, consider filling out the form by clicking the button below.

Fill Out Do Not Resuscitate Order Here

In the state of California, the Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals wishing to express their preferences regarding medical interventions in emergency situations. This form allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures if their heart stops beating or they stop breathing. It is particularly important for those with terminal illnesses or severe medical conditions, as it ensures that their wishes are respected during critical moments. The DNR form must be completed and signed by the patient or their legally authorized representative, and it requires the signature of a physician to be valid. Once properly executed, the form should be readily available in the patient's medical records and should accompany them in any healthcare setting. Understanding the nuances of this form can empower individuals to make informed decisions about their end-of-life care, fostering a sense of control and peace of mind in what can be an overwhelming time.

Document Specifics

Fact Name Description
Definition A Do Not Resuscitate (DNR) Order is a legal document that indicates a person's wish not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
Governing Law The California Do Not Resuscitate Order is governed by California Health and Safety Code Section 7190-7199.
Eligibility Any adult who is capable of making medical decisions can complete a DNR Order in California.
Form Requirements The DNR Order must be signed by the patient or their legal representative and a physician.
Availability California provides a standardized DNR form, which is widely accepted across healthcare facilities.
Revocation A DNR Order can be revoked at any time by the patient or their representative, verbally or in writing.
Emergency Services Emergency medical personnel must comply with a valid DNR Order when responding to a medical emergency.
Healthcare Provider Obligations Healthcare providers are required to honor a DNR Order as long as it is valid and properly executed.
Placement It is recommended that individuals keep their DNR Order in an easily accessible location, such as on their refrigerator or with their medical records.
Public Awareness California encourages public awareness and education about DNR Orders through various health organizations.

Key takeaways

When filling out and using the California Do Not Resuscitate Order (DNR) form, it is essential to understand its purpose and implications. Here are key takeaways to consider:

  • The DNR form allows individuals to refuse resuscitation in case of cardiac arrest or respiratory failure.
  • It must be signed by a physician and the patient or their legal representative.
  • Ensure that the form is completed clearly and accurately to avoid any confusion during a medical emergency.
  • Keep the original signed form in a safe but accessible location, such as a medical file or with a trusted family member.
  • Provide copies of the DNR form to your healthcare providers, hospital, and emergency medical services.
  • Review the DNR order regularly, especially if there are changes in your health status or wishes.
  • Understand that the DNR order is only effective in California and may not be recognized in other states.

California Do Not Resuscitate Order Example

California Do Not Resuscitate (DNR) Order

This Do Not Resuscitate (DNR) Order is created in accordance with California law, specifically Health and Safety Code Section 777. This order instructs healthcare providers to withhold cardiopulmonary resuscitation (CPR) in the event of cardiac arrest.

Patient Information:

  • Patient Name: ___________________________
  • Date of Birth: ___________________________
  • Address: ________________________________
  • City, State, Zip Code: ________________

Physician Information:

  • Physician Name: ___________________________
  • Medical License Number: _______________
  • Contact Number: ________________________

Date of Order: ________________________

This form must be signed by the patient, or if the patient is unable to sign, by an authorized representative. Below are the signatures needed for this order to be valid:

Patient Signature: __________________________________
Date: ______________________

Authorized Representative Signature (if applicable): ______________________
Relationship to Patient: ______________________
Date: ______________________

Physician Signature: __________________________________
Date: ______________________

Instructions for Use:

  1. Print this document and fill in the required information.
  2. Ensure that all necessary signatures are obtained.
  3. Keep a copy in the patient's medical records and provide a copy to the patient or their authorized representative.
  4. Review regularly to ensure it reflects current wishes.

Important Facts about California Do Not Resuscitate Order

What is a Do Not Resuscitate (DNR) Order in California?

A Do Not Resuscitate Order (DNR) is a legal document that allows individuals to express their wishes regarding resuscitation efforts in the event of cardiac or respiratory arrest. In California, a DNR order specifically instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if the person’s heart stops beating or they stop breathing. This order reflects a person's desire to avoid aggressive life-saving measures when they are terminally ill or in a state of irreversible decline.

Who can request a DNR Order?

In California, a DNR order can be requested by an adult who is capable of making their own healthcare decisions. If the individual is unable to make decisions due to incapacity, a legally authorized representative, such as a spouse, adult child, or legal guardian, may request a DNR order on their behalf. It’s essential that the person requesting the order understands the implications and is acting in the best interest of the individual whose wishes are being honored.

How do I obtain a DNR Order in California?

To obtain a DNR order, you must complete a specific form known as the "California Do Not Resuscitate (DNR) Form." This form is available through various healthcare providers, hospitals, and online resources. After filling out the form, it must be signed by both the patient (or their representative) and a physician. Once completed, the DNR order should be placed in a prominent location, such as on the refrigerator or with other important medical documents, to ensure it is easily accessible to emergency responders and healthcare providers.

Will a DNR Order affect other medical treatments?

A DNR order specifically pertains to resuscitation efforts and does not affect other medical treatments. Patients with a DNR order can still receive all other forms of medical care, including medications, pain relief, and comfort measures. It is important for individuals to communicate their broader healthcare wishes, possibly through an advance healthcare directive, to ensure their overall treatment preferences are understood and respected.

Can a DNR Order be revoked?

Yes, a DNR order can be revoked at any time by the individual who signed it or their authorized representative. To revoke the order, simply destroy the original DNR form and inform healthcare providers of the decision. It is advisable to communicate this change clearly to family members and medical personnel to avoid any confusion in emergency situations.

What should I do if I change my mind about my DNR Order?

If you change your mind about your DNR order, it is crucial to take immediate steps to ensure that your new wishes are communicated effectively. This involves revoking the existing DNR order, as mentioned earlier, and possibly completing a new form that reflects your current wishes. Additionally, inform your healthcare providers, family members, and anyone else involved in your care about your decision. Clear communication helps ensure that your preferences are honored in any medical situation.

Documents used along the form

When considering end-of-life care, individuals may find it helpful to have various documents that complement the California Do Not Resuscitate Order (DNR) form. These documents can provide clarity and guidance to healthcare providers and loved ones during critical moments. Below are some important forms that are often used alongside the DNR.

  • Advance Healthcare Directive: This document allows individuals to specify their healthcare preferences and appoint someone to make medical decisions on their behalf if they become unable to do so. It covers a range of medical situations, not just resuscitation.
  • California Motor Vehicle Bill of Sale: This form is essential for documenting the transfer of ownership for a motor vehicle, providing necessary details about the vehicle and the parties involved in the transaction. For more information, visit freebusinessforms.org/.
  • Physician Orders for Life-Sustaining Treatment (POLST): The POLST form is a medical order that outlines a patient’s preferences for treatment in emergency situations. It is intended for individuals with serious illnesses and ensures that their wishes are respected by healthcare providers.
  • Living Will: A living will is a type of advance directive that specifically addresses an individual's wishes regarding life-sustaining treatments and procedures. It can guide healthcare providers and family members in making decisions when the individual is unable to communicate.
  • Durable Power of Attorney for Healthcare: This document designates a trusted person to make healthcare decisions on behalf of the individual if they are incapacitated. It is an important tool for ensuring that someone who understands the individual's values and wishes can advocate for them.

Having these documents in place can provide peace of mind and ensure that your healthcare preferences are honored. It is essential to discuss these options with loved ones and healthcare providers to create a comprehensive plan that reflects your values and wishes.

Consider More Do Not Resuscitate Order Forms for US States

Dos and Don'ts

When filling out the California Do Not Resuscitate (DNR) Order form, it’s important to approach the process with care and clarity. Here’s a list of things you should and shouldn’t do:

  • Do: Ensure you understand what a DNR order means. It indicates that you do not wish to receive CPR or other life-saving measures in case of cardiac or respiratory arrest.
  • Do: Discuss your wishes with your healthcare provider. They can help clarify any questions and guide you through the process.
  • Do: Complete the form accurately. Fill in all required fields, including your name, date of birth, and signature.
  • Do: Keep a copy of the completed DNR order. Share it with your healthcare team and loved ones to ensure everyone is aware of your wishes.
  • Don't: Rush through the form. Take your time to consider your choices and the implications of a DNR order.
  • Don't: Leave the form unsigned. An unsigned DNR order may not be honored by medical personnel.
  • Don't: Forget to review your DNR order periodically. Your preferences may change over time, and it’s important to keep the document updated.