Official California Do Not Resuscitate Order Form

Official California Do Not Resuscitate Order Form

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. This form ensures that medical personnel respect the individual's decision not to receive cardiopulmonary resuscitation (CPR) or other life-saving measures. Understanding the implications and proper use of this form is essential for both patients and healthcare providers.

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In California, the Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals who wish to express their preferences regarding medical interventions in the event of a life-threatening situation. This form allows patients to communicate their desire not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining measures if their heart stops or they stop breathing. It is important to understand that a DNR order is not a declaration of the end of life; rather, it is a way for individuals to maintain control over their medical care, ensuring that their wishes are respected during critical moments. The form must be signed by the patient and their physician, making it legally binding. Additionally, it is essential for individuals to discuss their wishes with family members and healthcare providers to ensure clarity and understanding. By having a DNR order in place, patients can alleviate the burden of decision-making from their loved ones during an already stressful time, allowing for a more peaceful and dignified approach to end-of-life care.

California Do Not Resuscitate Order Sample

California Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is established in accordance with California state law, specifically California Health and Safety Code Sections 7190-7199. This document should be presented in a situation where a patient wishes to refuse resuscitative measures.

By completing this form, you are making a legally binding decision regarding your medical care. Please ensure that the information provided is accurate and complete.

Patient Information:

  • Name: _______________________________
  • Date of Birth: ________________________
  • Address: _____________________________
  • City: ________________________________
  • State: _______________________________
  • ZIP Code: ___________________________

Physician Information:

  • Physician Name: ______________________
  • Medical License Number: ______________
  • Contact Number: ______________________

Desired Order:

I, the undersigned, do not wish to receive resuscitative measures in the event of cardiac or respiratory arrest.

Signatures:

  • Patient Signature: _____________________ Date: ______________
  • Witness Signature: _____________________ Date: ______________
  • Physician Signature: ____________________ Date: ______________

This DNR Order remains valid until revoked by the patient or their legally authorized representative.

Important Notice:

It is recommended to discuss this decision with your healthcare provider and family members. A copy of this completed document should be kept with your medical records and shared with your care team.

Documents used along the form

A California Do Not Resuscitate (DNR) Order is an important document that allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. Along with the DNR form, there are several other documents that can help clarify a person's healthcare preferences. Here is a list of these related forms and documents.

  • Advance Healthcare Directive: This document allows individuals to outline their healthcare preferences and appoint someone to make medical decisions on their behalf if they become unable to do so.
  • Power of Attorney for Healthcare: This legal document designates a specific person to make healthcare decisions for someone if they are incapacitated. It can work in conjunction with an Advance Healthcare Directive.
  • Trailer Bill of Sale: The Illinois Templates PDF provides a necessary form that acts as proof of ownership transfer for trailers, essential for legal documentation during a sale.
  • Physician Orders for Life-Sustaining Treatment (POLST): This form translates a patient's wishes regarding life-sustaining treatments into actionable medical orders. It is often used for those with serious illnesses.
  • Living Will: A living will specifies what types of medical treatment an individual does or does not want in the event they are unable to communicate their wishes.
  • Healthcare Proxy: This document appoints an individual to make medical decisions for someone else, similar to a Power of Attorney for Healthcare, but typically more focused on immediate healthcare decisions.
  • Do Not Hospitalize Order: This order indicates that a patient should not be taken to a hospital for treatment, aligning with their wishes for end-of-life care.
  • Patient Preferences Form: This form allows patients to express their preferences for various medical treatments and interventions, providing guidance to healthcare providers.

Having these documents in place can provide clarity and ensure that healthcare providers respect an individual's wishes. It is crucial to discuss these options with family members and healthcare providers to ensure everyone understands the person's preferences and intentions.

Discover Other Common Do Not Resuscitate Order Forms for US States

Key takeaways

When considering the California Do Not Resuscitate (DNR) Order form, it is essential to understand its purpose and the steps involved in completing it. Here are some key takeaways to keep in mind:

  1. Understand the Purpose: A DNR order instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a person's heart stops or they stop breathing.
  2. Eligibility: The DNR order is intended for individuals with a serious medical condition who wish to avoid aggressive life-saving measures.
  3. Consult with Healthcare Providers: Before filling out the form, discussing your wishes with a healthcare provider is crucial. They can provide valuable insights and guidance.
  4. Complete the Form Accurately: Fill out the DNR order form carefully, ensuring all required information is provided, including the patient's name, date of birth, and signature.
  5. Witness Requirements: The form must be signed by the patient and witnessed by either a healthcare provider or another individual who can attest to the patient's wishes.
  6. Keep Copies Accessible: After completing the DNR order, make several copies. Share them with family members and keep one in a visible location, such as on the refrigerator.
  7. Review Regularly: Revisit the DNR order periodically, especially if there are changes in health status or personal wishes. It is important to ensure that the document reflects current intentions.

By understanding these key points, individuals can make informed decisions about their end-of-life care preferences in California.

Document Properties

Fact Name Description
Definition A California Do Not Resuscitate (DNR) Order is a legal document that allows individuals to refuse resuscitation in the event of cardiac arrest.
Governing Law The DNR Order is governed by California Health and Safety Code Section 7180-7190.
Eligibility Any adult may complete a DNR Order if they are capable of making their own medical decisions.
Signature Requirement The form must be signed by the patient or their legal representative, along with a physician's signature.
Form Availability The California DNR Order form is available online through the California Department of Public Health.
Medical Personnel Compliance Healthcare providers are required to comply with a valid DNR Order as long as it is properly executed.
Revocation A DNR Order can be revoked at any time by the patient or their legal representative.
Emergency Medical Services Emergency medical services personnel must honor the DNR Order in pre-hospital settings.

Frequently Asked Questions

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

A Do Not Resuscitate Order is a legal document that allows individuals to refuse cardiopulmonary resuscitation (CPR) in the event of a medical emergency where their heart stops beating or they stop breathing. In California, this order is specifically designed for patients who have a terminal illness or a condition that significantly limits their life expectancy. It ensures that their wishes regarding end-of-life care are respected by medical professionals.

How do I obtain a DNR Order in California?

To obtain a DNR Order, you must first discuss your wishes with your healthcare provider. They can help you understand the implications of a DNR and whether it is appropriate for your situation. If you and your doctor agree, you will need to complete the official California DNR form. This form must be signed by both you and your physician. Once completed, make sure to keep copies in accessible locations, such as with your medical records and at home.

Who can request a DNR Order?

Any adult who is capable of making their own medical decisions can request a DNR Order. This includes individuals with terminal illnesses or severe medical conditions. In cases where the patient is unable to make decisions, a legally authorized representative, such as a family member or healthcare proxy, may request a DNR on their behalf. It is crucial that the person requesting the order understands the patient's wishes and values.

What should I do with the DNR Order once it is completed?

After completing the DNR Order, you should keep it in a place where it can be easily accessed by emergency medical personnel and healthcare providers. It is advisable to carry a copy with you at all times, especially if you are traveling or going to a hospital. Additionally, inform your family and close friends about your DNR status so they can advocate for your wishes if necessary.

Can I change or revoke my DNR Order?

Yes, you can change or revoke your DNR Order at any time. If you decide to revoke it, you should inform your healthcare provider and destroy any copies of the original DNR form. If you wish to create a new DNR Order, you will need to go through the process of completing a new form and obtaining your physician's signature again.

What happens if I don’t have a DNR Order in place?

If you do not have a DNR Order, medical personnel are required to perform resuscitation efforts if your heart stops or you stop breathing. This can include chest compressions, intubation, and other life-saving measures. If you have specific wishes about your end-of-life care, it is essential to communicate those to your healthcare provider and consider completing a DNR Order to ensure your preferences are honored.

Misconceptions

Understanding the California Do Not Resuscitate (DNR) Order form is essential for patients and their families. Several misconceptions can lead to confusion about its purpose and implications. Here are eight common misconceptions clarified:

  1. A DNR order means I will not receive any medical care. This is not true. A DNR order specifically addresses resuscitation efforts during cardiac arrest or respiratory failure. Patients can still receive other types of medical care.
  2. Only terminally ill patients can have a DNR order. This misconception is incorrect. Any patient, regardless of their health status, can request a DNR order if they wish to avoid resuscitation in specific situations.
  3. A DNR order is the same as a living will. This is misleading. A living will outlines a person's wishes regarding medical treatment in general, while a DNR order specifically pertains to resuscitation efforts.
  4. I need a lawyer to complete a DNR order. This is not necessary. Patients can complete the DNR form without legal assistance. However, it is advisable to discuss it with healthcare providers.
  5. A DNR order is permanent and cannot be changed. This is false. A DNR order can be revoked or modified at any time by the patient or their designated representative.
  6. Healthcare providers will ignore my wishes if I have a DNR order. This is incorrect. Healthcare providers are required to respect a valid DNR order and will follow the patient's wishes as documented.
  7. Having a DNR order means I will not receive pain relief or comfort care. This is a misconception. Patients with a DNR order are still entitled to receive pain management and other forms of comfort care.
  8. I can only get a DNR order through my doctor. This is not entirely accurate. While healthcare providers often assist in completing the form, patients can also obtain and fill out the DNR order independently.

By addressing these misconceptions, individuals can make informed decisions regarding their medical care preferences and ensure their wishes are clearly communicated.