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Legal Do Not Resuscitate Order Form for the State of California

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Additional State-specific Do Not Resuscitate Order Forms

What Does a Dnr Mean - Discussions about a Do Not Resuscitate Order can be sensitive and require careful consideration.

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California Do Not Resuscitate Order Sample

California Do Not Resuscitate (DNR) Order

This Do Not Resuscitate Order (DNR) is prepared pursuant to California state law, specifically California Health and Safety Code Section 7180-7182. It serves as a directive regarding medical treatment in the event of cardiac or respiratory arrest.

Please complete the following information:

  • Patient's Full Name: ___________________________________________
  • Date of Birth: ______________________________________________
  • Patient's Address: ___________________________________________
  • Patient's Phone Number: _______________________________________
  • Healthcare Provider's Name: ___________________________________
  • Healthcare Provider's Phone Number: ____________________________

This DNR Order is effective when signed by the patient and their healthcare provider. Please ensure the following signatures are obtained:

  1. Patient's Signature: ________________________________________
  2. Date: ________________________________________________
  3. Healthcare Provider's Signature: ___________________________
  4. Date: ________________________________________________

It is important to discuss this decision with family members and your healthcare provider. This document must be honored by all healthcare professionals and facilities.

For further assistance or to ensure proper completion, please consult with your healthcare provider.

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Instructions on Utilizing California Do Not Resuscitate Order

Filling out the California Do Not Resuscitate Order form requires careful attention to detail. This document allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. It is important to follow the steps accurately to ensure that the form is valid and reflects the individual's preferences.

  1. Obtain the California Do Not Resuscitate Order form. This can be accessed online or through healthcare providers.
  2. Fill in your personal information, including your name, date of birth, and address, in the designated sections.
  3. Indicate whether you have a healthcare agent or proxy by checking the appropriate box. If you do, provide their contact information.
  4. Clearly state your wishes regarding resuscitation by checking the relevant boxes. You may choose to decline or accept specific medical interventions.
  5. Sign and date the form at the bottom. This signature must be yours, confirming that you understand and agree to the contents of the form.
  6. Have the form witnessed by two individuals who are not related to you or your healthcare agent. They must also sign and date the form.
  7. Make copies of the completed form for your records and distribute them to your healthcare provider and any family members or friends involved in your care.

Misconceptions

Understanding the California Do Not Resuscitate (DNR) Order can be challenging. Here are seven common misconceptions that people often have about this important legal document:

  1. A DNR means I will not receive any medical care.

    This is not true. A DNR specifically relates to resuscitation efforts in the event of cardiac or respiratory arrest. You will still receive other medical treatments as needed.

  2. I need a lawyer to complete a DNR form.

    While legal advice can be helpful, it is not necessary to have a lawyer to fill out a DNR form. The form is designed to be straightforward and can be completed by individuals or their healthcare proxies.

  3. A DNR is only for terminally ill patients.

    This is a misconception. Anyone can request a DNR order, regardless of their health status. It is a personal choice based on individual values and preferences.

  4. Once I sign a DNR, I cannot change my mind.

    You can revoke or change your DNR order at any time. It’s important to communicate any changes to your healthcare providers and ensure that your new wishes are documented.

  5. A DNR applies in all medical situations.

    This is incorrect. A DNR order specifically applies to situations involving resuscitation. It does not affect other medical interventions or treatments you may want.

  6. Healthcare providers will not respect my DNR wishes.

    Healthcare professionals are legally obligated to honor a valid DNR order. It is important to ensure that the order is properly completed and easily accessible to your medical team.

  7. I can only have a DNR if I am in a hospital.

    A DNR can be established in various settings, including at home or in long-term care facilities. It is crucial to discuss your wishes with your healthcare provider to ensure they are documented appropriately.

Being informed about the California DNR Order can help you make decisions that align with your healthcare preferences. Always consult with your healthcare provider for guidance tailored to your situation.

Documents used along the form

In California, the Do Not Resuscitate (DNR) Order form is a critical document for individuals wishing to express their preferences regarding resuscitation efforts in the event of a medical emergency. However, several other forms and documents complement the DNR to ensure comprehensive healthcare planning and decision-making. Below is a list of five essential documents that often accompany the DNR form.

  • Advance Healthcare Directive: This document allows individuals to specify their healthcare preferences and appoint a trusted person to make medical decisions on their behalf if they become unable to do so. It covers a broader range of medical treatment options beyond resuscitation.
  • Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that translates a patient’s wishes about life-sustaining treatments into actionable medical orders. Unlike a DNR, which specifically addresses resuscitation, POLST can cover various treatments, including the use of feeding tubes and antibiotics.
  • Living Will: A living will is a legal document that outlines an individual’s wishes regarding end-of-life care and medical treatments they do or do not wish to receive. It serves as a guide for healthcare providers and family members when making decisions about care.
  • Healthcare Power of Attorney: This document designates a person to make medical decisions on behalf of the individual if they are incapacitated. It is crucial for ensuring that someone trusted can advocate for the individual’s healthcare preferences.
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  • Do Not Intubate (DNI) Order: Similar to a DNR, a DNI specifically instructs healthcare providers not to place a breathing tube in the event of respiratory failure. This order is particularly relevant for patients who may wish to avoid invasive procedures while still receiving other forms of care.

Each of these documents plays a vital role in ensuring that an individual’s healthcare wishes are respected and followed. Together with the DNR Order, they provide a framework for making informed decisions during critical moments, ultimately promoting patient autonomy and peace of mind.