Attorney-Verified Do Not Resuscitate Order Document for California

A California 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. This form ensures that healthcare providers respect your decisions about life-sustaining treatments. If you want to take control of your medical care, consider filling out the form by clicking the button below.

Article Guide

The California Do Not Resuscitate (DNR) Order form serves as a critical document for individuals who wish to make their end-of-life wishes clear, particularly regarding resuscitation efforts in the event of cardiac arrest or respiratory failure. This legally binding form allows patients to express their desire not to receive cardiopulmonary resuscitation (CPR) or other life-sustaining treatments if they are unable to communicate their preferences during a medical emergency. It is essential for individuals to understand that the DNR Order must be signed by a physician and, in many cases, should be accompanied by discussions with family members and healthcare providers to ensure everyone is aware of the patient’s wishes. The form includes sections for the patient's information, the physician's certification, and a signature line, making it straightforward to complete. Additionally, it is important to note that a DNR Order is specific to the situation and does not affect other medical treatments or decisions about care. Understanding the implications of this form can empower individuals to take control of their healthcare decisions and ensure that their preferences are respected in critical moments.

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California Do Not Resuscitate Order (DNR)

This Do Not Resuscitate Order (DNR) is a legal document that expresses an individual's wish not to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest. This document is governed by California law, specifically the California Health and Safety Code Sections 7180-7190.

Please fill in the blanks with the appropriate information:

Patient's Full Name: _______________________________
Date of Birth: _______________________________
Patient's Address: _______________________________
City, State, Zip Code: _______________________________
Patient's Phone Number: _______________________________
Health Care Provider's Name: _______________________________
Health Care Provider's Phone Number: _______________________________

This DNR order is valid only if signed by the patient or their legally authorized representative. The following individuals may act as a representative:

Spouse
Adult child
Parent
Sibling
Other legal guardian

Signature of Patient or Authorized Representative: _______________________________

Date: _______________________________

Witnesses are required to validate this order. The following individuals may serve as witnesses:

Any adult who is not a relative of the patient
Any adult who is not the patient's health care provider

Signature of Witness 1: _______________________________

Date: _______________________________

Signature of Witness 2: _______________________________

Date: _______________________________

It is recommended that a copy of this DNR order be kept in a prominent place, such as on the refrigerator or with other important medical documents. Additionally, inform family members and health care providers about this decision.

↓ Do Not Resuscitate Order

PDF Form Characteristics

Fact Name	Description
Purpose	The California Do Not Resuscitate Order (DNR) form is designed to communicate a patient's wishes regarding resuscitation in the event of cardiac or respiratory arrest.
Governing Law	The DNR form is governed by California Health and Safety Code Section 7190-7199.
Eligibility	Any adult with decision-making capacity can complete a DNR order. Minors require consent from a parent or legal guardian.
Signature Requirement	The form must be signed by the patient or their legal representative, along with a physician's signature.
Revocation	Patients can revoke their DNR order at any time. This can be done verbally or by destroying the form.
Availability	The DNR form is available online and can be printed for use. It should be kept in an accessible location.

Instructions on Utilizing California Do Not Resuscitate Order

Filling out the California Do Not Resuscitate Order form requires careful consideration. This document is essential for communicating your wishes regarding resuscitation in medical emergencies. Follow these steps to complete the form accurately.

Obtain the California Do Not Resuscitate Order form. You can find it online or request a copy from your healthcare provider.
Read the instructions on the form thoroughly. Understanding each section is crucial for proper completion.
Fill in your personal information, including your full name, date of birth, and address.
Designate a healthcare representative if desired. Include their name and contact information.
Clearly state your wishes regarding resuscitation. Indicate whether you do or do not want resuscitation efforts.
Sign and date the form. Ensure your signature is clear and legible.
Have the form witnessed by two adults who are not related to you and do not stand to gain from your estate.
Make copies of the completed form. Keep one for your records and provide copies to your healthcare provider and family members.

After completing the form, ensure that it is easily accessible to those who may need it. Share your wishes with family and healthcare providers to ensure they understand your preferences.

Important Facts about California Do Not Resuscitate Order

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

A Do Not Resuscitate Order is a legal document that allows an individual to refuse specific life-saving measures, such as cardiopulmonary resuscitation (CPR), in the event of a medical emergency. In California, a DNR order is typically used by individuals with serious medical conditions who wish to avoid aggressive medical interventions when their heart stops or they stop breathing.

Who can request a DNR Order?

In California, a DNR order can be requested by a patient who is capable of making their own medical decisions. If the patient is unable to communicate their wishes, a legally authorized representative, such as a spouse, adult child, or designated healthcare proxy, may request a DNR order on their behalf.

How do I obtain a DNR Order form in California?

The DNR order form can be obtained from various sources, including hospitals, healthcare providers, and online resources. The California Department of Public Health provides a downloadable version of the form on its website. It is essential to ensure that the form is filled out correctly and signed to be valid.

What information is required on the DNR Order form?

The DNR order form requires specific information, including the patient's name, date of birth, and a statement indicating the patient's wishes regarding resuscitation. Additionally, the form must be signed by the patient or their authorized representative, as well as a physician who agrees with the patient's decision.

Is a DNR Order valid in all healthcare settings?

Yes, a properly executed DNR order is valid in all healthcare settings in California, including hospitals, nursing homes, and at home. However, it is important to communicate the existence of the DNR order to all healthcare providers involved in the patient's care to ensure that their wishes are respected.

Can I change or revoke my DNR Order?

A DNR order can be changed or revoked at any time by the patient or their authorized representative. To revoke the order, the individual should communicate their decision to their healthcare provider and, if possible, destroy the original DNR form. It is advisable to document the change in writing to avoid any confusion in the future.

What should I do if my loved one has a DNR Order?

If your loved one has a DNR order, it is crucial to keep a copy of the form in an easily accessible location. Inform all family members and caregivers about the order. Additionally, ensure that healthcare providers are aware of the DNR order, especially during medical emergencies, to respect the individual's wishes.

What are the implications of having a DNR Order?

Having a DNR order means that healthcare providers will not perform CPR or other resuscitative measures if the patient experiences cardiac arrest or respiratory failure. It is essential to understand that a DNR order does not affect other types of medical treatment. Patients will still receive appropriate care and comfort measures, even if they have a DNR order in place.

Common mistakes

Filling out the California Do Not Resuscitate (DNR) Order form can be a sensitive and crucial task. However, many individuals make common mistakes that can lead to confusion or even legal issues. One frequent error is failing to sign the document. A DNR form must be signed by the patient or their authorized representative. Without this signature, the form is not valid.

Another mistake is not having the form properly witnessed. California law requires that the DNR form be signed in the presence of two witnesses, or a notary public. Skipping this step can render the document ineffective. Additionally, individuals often forget to date the form. A missing date can create uncertainty about when the order was established, which may complicate matters during a medical emergency.

People sometimes overlook the importance of clear communication with healthcare providers. It's essential to discuss the DNR order with doctors and family members. Failing to do so can lead to misunderstandings about the patient's wishes. Furthermore, some individuals may fill out the form without fully understanding its implications. A DNR order means that no resuscitation efforts will be made, and it’s important to consider this decision carefully.

Another common mistake involves using outdated forms. The California DNR Order form has specific requirements that may change over time. Always ensure you are using the most current version to avoid any issues. Additionally, individuals might not keep copies of the signed form. It’s crucial to have multiple copies accessible to healthcare providers and family members to ensure that everyone is aware of the patient's wishes.

Lastly, some people make the mistake of not reviewing the DNR order regularly. Life circumstances can change, and so can a person’s preferences regarding medical care. Regularly reviewing and updating the DNR form can help ensure that it accurately reflects the patient's current wishes.

Documents used along the form

When considering end-of-life care, it's essential to understand the various documents that can work in tandem with a California Do Not Resuscitate (DNR) Order. Each of these documents serves a unique purpose and can help ensure that an individual's healthcare wishes are respected. Below is a list of commonly used forms and documents that may accompany a DNR order.

Advance Healthcare Directive: This document allows individuals to outline their healthcare preferences and appoint a healthcare agent to make decisions on their behalf if they become unable to do so.
Physician Orders for Life-Sustaining Treatment (POLST): A POLST form translates a patient's wishes regarding life-sustaining treatments into actionable medical orders, guiding healthcare providers in emergencies.
Living Will: A living will is a type of advance directive that specifies what types of medical treatment a person wishes or does not wish to receive in case of terminal illness or incapacity.
Durable Power of Attorney for Healthcare: This document designates someone to make healthcare decisions on behalf of the individual if they are unable to communicate their wishes.
Do Not Intubate (DNI) Order: Similar to a DNR, a DNI order specifically states that a patient does not want to be intubated or placed on a ventilator in the event of respiratory failure.
Comfort Care Order: This order emphasizes palliative care measures, focusing on providing comfort and alleviating pain rather than prolonging life through aggressive treatments.
Health Care Proxy: A health care proxy is a document that appoints someone to make medical decisions on behalf of another person if they are unable to do so, similar to a durable power of attorney.
Patient Preferences Form: This form allows patients to express their preferences regarding specific medical treatments and interventions, facilitating discussions with healthcare providers.
Emergency Medical Services (EMS) DNR Form: This form is used specifically for emergency medical personnel to recognize a patient's DNR wishes in out-of-hospital settings.

Understanding these documents can empower individuals to communicate their healthcare wishes clearly. By having the appropriate forms in place, patients and their families can ensure that their preferences are honored during critical moments. It is always advisable to consult with a legal or healthcare professional when navigating these important decisions.

Similar forms

Living Will: This document outlines an individual's preferences for medical treatment in situations where they cannot communicate their wishes. Like a Do Not Resuscitate Order (DNR), it addresses end-of-life care.
Health Care Proxy: A health care proxy designates a person to make medical decisions on behalf of an individual. This is similar to a DNR in that it involves decisions regarding life-sustaining treatment.
Durable Power of Attorney for Health Care: This document grants someone the authority to make health care decisions for another person. It parallels a DNR by focusing on medical treatment preferences.
Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that specifies which treatments a patient wishes to receive. Like a DNR, it is intended for patients with serious health conditions.
Advance Directive: An advance directive is a broader term that includes both living wills and health care proxies. It serves to communicate a person's wishes regarding medical treatment, similar to a DNR.
Do Not Intubate (DNI) Order: A DNI order specifically states that a patient should not be intubated. It is related to a DNR in that both address the extent of medical intervention desired.
Organ Donation Consent: This document indicates a person's wishes regarding organ donation after death. It is similar to a DNR in that both deal with end-of-life decisions.
Comfort Care Order: A comfort care order focuses on providing relief from pain and stress without aggressive treatment. It aligns with a DNR by prioritizing quality of life over life-prolonging measures.
Patient Bill of Rights: This document outlines the rights of patients regarding their medical care. It relates to a DNR by emphasizing the importance of patient autonomy in health care decisions.
Emergency Medical Services (EMS) Protocols: EMS protocols provide guidelines for emergency responders when treating patients. They often reference DNR orders to ensure that a patient's wishes are respected during emergencies.

Dos and Don'ts

When completing the California Do Not Resuscitate (DNR) Order form, it is important to approach the process with care and consideration. Below is a list of things you should and shouldn't do to ensure that your wishes are clearly communicated.

Do discuss your decision with your healthcare provider to ensure you understand the implications.
Do ensure that the form is signed by you and your physician to make it legally valid.
Do keep copies of the completed form in accessible locations, such as with your medical records and at home.
Do inform your family members about your decision and provide them with copies of the form.
Do review your DNR order periodically to ensure it still reflects your wishes.

Don't fill out the form without fully understanding its contents and consequences.
Don't forget to date the form when you sign it, as this is essential for validation.
Don't assume that verbal instructions will be sufficient; written documentation is necessary.
Don't neglect to update the form if your health status or wishes change.
Don't leave the form in a place where it may be overlooked or lost during a medical emergency.

Misconceptions

Understanding the California Do Not Resuscitate (DNR) Order form is crucial for individuals and families making end-of-life decisions. However, several misconceptions can lead to confusion. Here are six common misunderstandings:

A DNR order means no medical care at all. Many people believe that a DNR order indicates a complete refusal of all medical treatment. In reality, a DNR specifically relates to resuscitation efforts during a cardiac arrest. Other forms of medical care, such as pain management and comfort measures, can still be provided.
Anyone can sign a DNR order. It is a common belief that any family member can sign a DNR order for a loved one. However, only the individual themselves or their legally authorized representative can complete and sign the form.
A DNR order is permanent. Some think that once a DNR order is in place, it cannot be changed. In fact, individuals can revoke or modify their DNR orders at any time, as long as they are mentally competent to do so.
Having a DNR order means giving up on life. This misconception suggests that choosing a DNR is equivalent to refusing to fight for life. In truth, many individuals choose a DNR to ensure they receive a natural death without unnecessary interventions, reflecting their values and preferences.
DNR orders are only for the elderly or terminally ill. Many people assume that DNR orders are only relevant for older adults or those with terminal illnesses. However, anyone can have a DNR order, regardless of age or health status, if they wish to refuse resuscitation in specific circumstances.
Healthcare providers will not respect a DNR order. Some fear that medical staff may ignore a DNR order. In California, healthcare providers are legally obligated to honor valid DNR orders. Communication with healthcare teams is essential to ensure that everyone understands and respects the patient's wishes.

Addressing these misconceptions can help individuals make informed decisions regarding their healthcare preferences and advance directives.

Key takeaways

When considering a Do Not Resuscitate (DNR) Order in California, it's essential to understand the implications and procedures involved. Here are some key takeaways to guide you through the process:

Understand the Purpose: A DNR Order informs medical personnel that you do not wish to receive cardiopulmonary resuscitation (CPR) in the event of cardiac or respiratory arrest.
Eligibility: Any adult can create a DNR Order. It’s often used by individuals with terminal illnesses or serious health conditions.
Consult with Healthcare Providers: Before filling out the form, discuss your wishes with your doctor. They can provide valuable insights and help clarify any questions.
Complete the Form Accurately: Ensure that you fill out the DNR Order form completely. Include your name, date of birth, and signature, along with the date of completion.
Witness Requirement: The form must be signed by either a physician or a licensed healthcare provider. A witness signature is not required.
Keep Copies Accessible: After completing the DNR Order, keep several copies in easily accessible locations. Share them with family members and your healthcare team.
Review Regularly: Revisit your DNR Order periodically, especially if your health status changes. Ensure that it still reflects your current wishes.

Understanding these key points can help you make informed decisions regarding end-of-life care and ensure your preferences are respected in critical situations.