Blank Do Not Resuscitate Order Form for California

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

A Do Not Resuscitate (DNR) Order in California is a legal document that tells healthcare professionals not to perform CPR (cardiopulmonary resuscitation) or advanced cardiac life support if a person's breathing or heartbeat stops. This is typically used by individuals with serious illnesses or who are at the end of their life, who choose not to undergo certain life-sustaining treatments. The aim is to allow natural death without aggressive interventions.

How can someone obtain a DNR order in California?

To obtain a DNR order in California, the individual must discuss their wishes with their healthcare provider. The healthcare provider will then review the person's health condition and, if appropriate, fill out the DNR form. The form must be signed by both the healthcare provider and the patient (or the patient’s legally recognized health care decision-maker if the patient is unable to sign themselves).

Where does a DNR order apply?

In California, a DNR order applies in all healthcare settings, including hospitals, nursing homes, and in the patient's own home. It also applies in non-healthcare settings if emergency medical personnel, such as paramedics or emergency medical technicians (EMTs), are called to the scene. The DNR order informs these professionals of the patient's decision to forgo resuscitation efforts.

Is the DNR order the same as an Advance Healthcare Directive?

No, a DNR order is not the same as an Advance Healthcare Directive, although both documents are related to end-of-life decisions. An Advance Healthcare Directive allows individuals to outline their healthcare preferences and appoint a healthcare agent to make decisions on their behalf if they're unable to do so. A DNR order specifically addresses the decision regarding CPR and advanced life support in cases where the patient's heart or breathing stops.

Can a DNR order be revoked or changed?

Yes, a DNR order can be revoked or changed at any time by the patient or their legally authorized decision-maker. To change their DNR status, the individual must communicate their new wishes to their healthcare provider, who will then update or cancel the DNR order as needed. It’s important to also communicate this change to any family members or others involved in the patient's care.

What is the difference between a prehospital DNR and a POLST form?

In California, a prehospital DNR specifically instructs emergency personnel not to perform CPR or other life-saving measures before a patient is hospitalized. A POLST (Physician Orders for Life-Sustaining Treatment), on the other hand, is a more comprehensive form that includes the patient's wishes regarding CPR but also addresses other types of life-sustaining treatments, such as intubation, antibiotic use, and feeding tubes, across various healthcare settings.

What should be done with the DNR order once it is completed?

Once a DNR order is completed, it should be kept in a location that is easily accessible to family members and caregivers and can quickly be presented to healthcare providers or emergency personnel when needed. Copies should also be given to the individual’s healthcare provider, local hospital, and potentially to family members or friends who are likely to be present in an emergency. If the individual has a POLST form as well, it is recommended to keep both documents together.

Filling out a California Do Not Resuscitate (DNR) Order form is an important step for those who wish to express their preferences regarding life-sustaining treatments. However, some common mistakes can make these directives unclear or invalid. By understanding these errors, individuals can ensure their wishes are respected.

1. Not using the most current form - The state periodically updates the DNR form to reflect new legal requirements or medical practices. Using an outdated version may result in a form that is not recognized by healthcare providers.

2. Incomplete information - Every field on the form needs to be filled out. Missing information can create confusion or delay in critical moments. This includes personal information, checking the appropriate boxes that apply, and especially the signature sections.

3. Failure to obtain required signatures - A valid DNR order must be signed by the individual (or their legally recognized health care decision-maker) and their physician. Overlooking these signatures invalidates the form.

4. Misunderstanding the form’s scope - Some people assume the DNR order applies to more medical interventions than it actually does. It’s solely about not receiving CPR in the event of cardiac or respiratory arrest. Other life-sustaining treatments need separate directives.

5. Not discussing the form with a healthcare provider - Before finalizing a DNR order, it's crucial to discuss it with a healthcare provider. This ensures that the individual fully understands what the DNR entails and the provider can clarify any misconceptions.

6. Not informing family members or caregivers - Family members, caregivers, or anyone involved in the person’s care should be made aware of the DNR order. It prevents any surprises and ensures that the person's wishes are honored.

7. Not keeping the document accessible - After completing the DNR order, it should be kept in a place where it can be easily found by emergency responders, like on the refrigerator or in an emergency medical kit. An inaccessible DNR order can be as good as not having one.

Attention to these details can significantly impact the effectiveness of a California DNR Order. It empowers individuals to have their healthcare wishes respected during critical moments. Recognizing these common mistakes and taking steps to avoid them ensures that one’s choices are clearly communicated and upheld.

When managing healthcare decisions, particularly those that are critical and sensitive like end-of-life preferences, the California Do Not Resuscitate (DNR) Order form often works in conjunction with several other vital documents. These documents together play a pivotal role in ensuring a person's healthcare wishes are clearly understood and adhered to by family members and healthcare providers. Each document complements the DNR order by covering different aspects of a person's healthcare and personal wishes. Below are additional forms and documents that are typically used alongside the California Do Not Resuscitate Order form.

• Advance Health Care Directive (AHCD): This powerful document allows an individual to outline specific healthcare preferences and appoint a trusted agent to make healthcare decisions on their behalf should they become unable to do so. The AHCD can specify wishes regarding the extent of medical intervention, organ donation preferences, and end-of-life care, offering a comprehensive guide to healthcare providers and family members.
• Physician Orders for Life-Sustaining Treatment (POLST): POLST complements the DNR by providing more detailed instructions about a range of life-sustaining treatments, in addition to resuscitation. This form is particularly useful for those with serious illnesses or frailty, as it goes beyond the directives of a DNR by addressing treatments such as mechanical ventilation, feeding tubes, and antibiotics, ensuring that a patient's wishes are followed across different care settings.
• Power of Attorney (POA) for Health Care: This document designates a person to act as an agent on behalf of the individual, making medical decisions if they are incapacitated. While similar to the AHCD, the POA for Health Care is strictly limited to medical decision-making, providing clarity and authority to a designated agent without encompassing broader health care directives.
• Living Will: A living will is a written statement that clearly outlines the types of medical treatments and life-sustaining measures an individual wishes to receive or avoid, in the event they are unable to communicate their decisions due to illness or incapacity. While there is overlap with the AHCD, a living will is specifically focused on end-of-life care, making it a critical companion to a DNR for expressing an individual's health care desires.

Together, these documents form a comprehensive framework that respects and protects an individual's healthcare wishes. Each plays a unique role in safeguarding personal autonomy by clearly outlining and communicating the individual's desires regarding medical treatment and interventions. When prepared in advance, these documents ensure that medical care aligns with the individual's values and wishes, bringing peace of mind to both the individual and their loved ones during challenging times.

• A Living Will is similar to a Do Not Resuscitate (DNR) order in that it allows individuals to outline their wishes for medical treatment in the event they become unable to communicate those preferences themselves. Both documents guide healthcare providers on how to proceed with medical care, focusing on the patient's autonomy and prioritized wishes.

• A Medical Power of Attorney (POA) delegates decision-making authority to another person regarding medical care when the individual cannot make decisions for themselves. This document is akin to a DNR order in that it prepares for a scenario where the individual's preferences need to be communicated by someone else due to incapacity.

• Advance Directives encompass a variety of documents, including living wills and DNR orders. They are plans individuals make about their healthcare in advance. The similarity lies in their function to ensure that the healthcare preferences of individuals are known and respected when they can no longer vocalize them.

• A Health Care Proxy, like a POA, allows an individual to appoint someone to make decisions about their health care if they are unable to do so. This role can include decisions about enforcing or not enforcing a DNR order, showing a connection in how both documents focus on executing healthcare wishes during incapacitation.

• Lastly, the POLST form (Physician Orders for Life-Sustaining Treatment) significantly mirrors the intents of a DNR form. It translates an individual's wishes regarding end-of-life care into actionable medical orders. Both documents are used to ensure that healthcare providers follow the patient's preferences, particularly in emergency or critical care situations.

When filling out the California Do Not Resuscitate (DNR) Order form, there are several important steps you should follow to ensure the document is completed accurately and recognized legally. To assist you, here are the do's and don'ts you'll want to keep in mind:

• Make sure the patient or their legally authorized representative signs the form to indicate their informed consent.
• Consult with a healthcare provider to fully understand the implications and scope of a DNR order.
• Ensure the form is clearly legible and all required fields are filled out accurately to avoid any misunderstandings in an emergency situation.
• Keep the original form in an easily accessible location and distribute copies to relevant family members and healthcare providers.

• Do not fill out the form without thoroughly discussing it with the patient (if possible) and their family to make sure everyone understands the patient's wishes.
• Avoid leaving sections of the form blank, as incomplete forms may not be legally binding or recognized in an emergency.
• Do not forget to review and update the form regularly, especially if the patient's health status or wishes change.
• Refrain from using ambiguous language or instructions that could lead to confusion or misinterpretation by medical personnel.

Many individuals in California may have misconceptions about Do Not Resuscitate (DNR) Orders. Misunderstandings can cause confusion and emotional distress for patients and their families when making important health care decisions. It's essential to clarify these misconceptions to support informed choices regarding end-of-life care.

• The DNR Order is only for the elderly. DNR Orders are not specific to age. They are intended for anyone with a serious illness or condition where they might not want resuscitation attempts in the event of cardiac or respiratory arrest, regardless of their age.

• Signing a DNR automatically means no medical treatment will be provided. This is not true. A DNR Order specifically relates to CPR (cardiopulmonary resuscitation) and does not affect other treatments for comfort and care that can be provided to manage pain and other symptoms.

• A DNR Order can only be implemented by a doctor. While a physician must approve the DNR Order, the request can originate from the patient or their healthcare power of attorney. The physician's role is to ensure the patient or their legal representative understands the implications of the Order and agrees to it.

• If you change your mind, a DNR Order cannot be reversed. Patients or their appointed healthcare decision-makers can rescind a DNR Order at any time. It's crucial for this decision to be communicated promptly to all concerned healthcare providers.

• DNR Orders are not valid across different settings. In California, DNR Orders are recognized in hospitals, at home, and in other healthcare settings. However, it is important to have the documentation readily accessible and to inform healthcare providers of its existence.

• DNR means "Do Not Treat." This is a common misconception. A DNR Order specifically addresses the wish not to have CPR in the event of a cardiac or respiratory arrest. It does not mean that other treatments, especially those meant to provide comfort or alleviate pain, will be withheld.

• A DNR Order is the same as a living will. These are two distinct documents. A DNR Order is a directive specifically about CPR, while a living will provides instructions for a broader range of end-of-life care decisions.

• Family consent is needed for a DNR Order to be valid. While it is always a good practice to discuss healthcare preferences with family, the consent required to enact a DNR Order is that of the patient or their legally authorized representative, not the family at large.

• Emergency responders will always know there is a DNR Order. It's crucial for DNR documentation to be accessible and visible in emergency situations. Emergency responders should be informed immediately upon their arrival if there is a DNR Order in place. Some individuals may choose to wear a DNR bracelet or necklace or place the Order in a visible location within the home.

• DNR Orders are permanent and must be included in a patient’s medical record. While a DNR Order is an important document that should be a part of a patient’s medical record, it is the responsibility of the patient or their healthcare proxy to ensure it is included and updated as needed. It can be revoked or modified according to the patient's wishes at any time.

Understanding what a DNR Order entails can empower individuals and their families to make choices that align with their values and wishes regarding medical care. Addressing these common misconceptions can help demystify the process, ensuring that decisions are made based on accurate information.

When dealing with the California Do Not Resuscitate (DNR) Order form, individuals should keep in mind several key points that ensure their wishes are respected in critical health situations. This form serves as a directive to health care providers regarding the withholding of resuscitative treatments in events where an individual’s heartbeat or breathing stops.

• The form must be filled out correctly to be considered legal and valid. It requires specific information about the individual, including their full name and date of birth, to avoid any confusion during emergency situations.
• A licensed physician must sign the DNR Order for it to be considered valid. Without a physician’s signature, the form will not be legally binding, and emergency personnel might not honor the patient's wishes.
• Clear communication with family members, healthcare agents, or those who may make healthcare decisions on behalf of the individual is crucial. They should be informed about the existence of the DNR Order and understand the individual's wishes.
• Carrying the original or a copy of the DNR Order at all times is important, as emergency personnel will need to see the document to honor its directives. A digital version on a smartphone or a tablet may also be practical in today’s digital age.
• The form specifies that CPR (Cardiopulmonary Resuscitation) should not be administered. This includes measures like chest compressions, artificial ventilation, advanced airway management, and emergency drugs.
• Making changes to a DNR Order is allowable but requires the completion of a new form and, again, the signature of a licensed physician. The most current form should replace any previous versions and be distributed accordingly to reflect the updated wishes.
• It’s recommended to review the DNR Order periodically, especially if the individual's health status changes. This ensures that the orders on the form align with the person's current health care preferences.
• A DNR Order is different from an Advance Health Care Directive, although both documents deal with end-of-life wishes. The latter allows individuals to outline more comprehensive health care instructions and appoint a health care agent.
• In an emergency, first responders and medical personnel are trained to look for DNR Orders. Informing them upon their arrival and displaying the form prominently at home can assist in these critical moments.

It is essential for individuals and their loved ones to understand these aspects of the California Do Not Resuscitate Order form to ensure that their healthcare preferences are honored during emergencies.