Printable California Do Not Resuscitate Order Template

When filling out the California Do Not Resuscitate Order form, it is important to follow certain guidelines. Here are ten things to keep in mind:

• Do clearly state your wishes regarding resuscitation.
• Do ensure that the form is signed and dated by you or your authorized representative.
• Do provide the name and contact information of your physician.
• Do discuss your decision with your family and healthcare providers.
• Do keep a copy of the completed form in a safe place.
• Don't leave any sections of the form blank; complete all required fields.
• Don't use the form if you change your mind without updating it.
• Don't forget to inform your healthcare team about the existence of the form.
• Don't assume that verbal instructions will be sufficient; written documentation is necessary.
• Don't hesitate to seek assistance if you have questions about the form.

When considering the California Do Not Resuscitate (DNR) Order form, it’s important to understand its purpose and how to properly fill it out. Here are some key takeaways to keep in mind:

1. Understand the Purpose: The DNR order is a legal document that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if your heart stops or you stop breathing.
2. Eligibility: This form is generally intended for individuals with serious health conditions who wish to avoid resuscitation efforts.
3. Consult with Healthcare Providers: Before filling out the form, discuss your wishes with your doctor or healthcare provider to ensure you understand the implications.
4. Complete the Form Accurately: Fill out all required sections clearly, including your name, date of birth, and the signature of your physician.
5. Witness Requirements: The form must be signed by either a witness or a notary public, depending on the specific instructions provided.
6. Keep Copies Accessible: After completing the DNR order, make copies and keep them in accessible places, such as your medical records or with family members.
7. Inform Family and Friends: Share your decision with loved ones so they understand your wishes and can advocate for you if necessary.
8. Review Regularly: Revisit your DNR order periodically, especially if your health status changes or if you have a change of heart about your wishes.
9. State-Specific Guidelines: Familiarize yourself with California’s specific laws and regulations regarding DNR orders to ensure compliance.
10. Emergency Medical Services (EMS): Make sure that EMS personnel are aware of your DNR order, as they need to see the physical document to honor your wishes.

By understanding these key points, you can navigate the process of filling out and utilizing the California DNR Order form with confidence and clarity.

• Misconception 1: A DNR means you will not receive any medical care.

This is incorrect. A Do Not Resuscitate (DNR) order specifically relates to resuscitation efforts, such as CPR. It does not prevent you from receiving other forms of medical treatment.

• Misconception 2: A DNR is only for terminally ill patients.

While many people associate DNR orders with terminal illnesses, anyone can choose to have a DNR, regardless of their health status. It’s a personal decision based on individual preferences.

• Misconception 3: A DNR is a legal document that must be notarized.

In California, a DNR does not need to be notarized to be valid. However, it should be signed by the patient or their authorized representative and a physician.

• Misconception 4: A DNR is permanent and cannot be changed.

This is false. A DNR can be revoked or modified at any time by the patient or their representative. It’s essential to communicate any changes to healthcare providers.

• Misconception 5: Healthcare providers will ignore a DNR if they believe it’s not in the patient’s best interest.

Healthcare providers are legally obligated to respect a valid DNR order. They cannot override it based on personal beliefs about the patient’s care.

• Misconception 6: A DNR only applies in hospitals.

A DNR order is applicable in any setting, including at home or in long-term care facilities. It should be clearly communicated to all caregivers and family members.

• Misconception 7: You need a lawyer to create a DNR.

Creating a DNR does not require legal assistance. Patients can discuss their wishes with their healthcare provider and fill out the appropriate form.

• Advance Healthcare Directive: This document allows individuals to outline their preferences for medical treatment in case they become unable to communicate their wishes. It serves as a comprehensive guide for healthcare providers, similar to a DNR in that it reflects the patient’s wishes regarding life-sustaining measures.
• Living Will: A living will is a specific type of advance directive. It details the types of medical treatment a person does or does not want in situations where they cannot express their wishes. Like a DNR, it focuses on end-of-life care decisions.
• Power of Attorney for Healthcare: This document designates someone to make healthcare decisions on behalf of an individual if they are unable to do so. While a DNR specifies actions to take or avoid, a power of attorney allows someone else to interpret and act on those wishes.
• Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that outlines a patient’s preferences for treatment in emergency situations. It is similar to a DNR in that it provides clear instructions to healthcare providers about the patient's wishes regarding resuscitation.
• Do Not Intubate Order: This order specifically instructs healthcare providers not to insert a breathing tube in the event of respiratory failure. It complements a DNR by addressing another aspect of resuscitation efforts.
• Do Not Hospitalize Order: This document requests that a patient not be taken to a hospital for treatment, particularly in cases of terminal illness. Like a DNR, it reflects a patient’s desire to avoid aggressive medical interventions.
• Comfort Care Order: A comfort care order prioritizes the alleviation of pain and discomfort without aggressive treatment measures. It aligns with the principles of a DNR by focusing on quality of life rather than prolonging life at all costs.
• End-of-Life Care Plan: This plan outlines the goals and preferences for care as a person approaches the end of life. It is similar to a DNR in that it aims to ensure the patient’s wishes are respected in their final days.
• Healthcare Proxy: A healthcare proxy appoints an individual to make medical decisions on behalf of someone else. This is akin to a DNR, as both documents aim to honor the patient’s wishes regarding medical care.