Fillable Do Not Resuscitate Order Form for California State

Steps to Using California Do Not Resuscitate Order

A Do Not Resuscitate (DNR) order in California is a legal form used by an individual to indicate that they do not want to receive cardiopulmonary resuscitation (CPR) if their heart stops beating or if they stop breathing. This document is a critical part of end-of-life planning for those who wish to have their healthcare preferences respected by medical personnel. Filling out the California DNR form requires careful attention to detail and an understanding of the specific steps to be followed to ensure the document is legally binding and effective.

To properly fill out the California Do Not Resuscitate Order form, follow these steps:

1. Obtain the most current version of the California DNR Order form from the California Department of Public Health's website or from a healthcare provider.
2. Read the form thoroughly to understand all the conditions and implications of signing a DNR order.
3. Section 1: The person for whom the DNR order is intended (the patient) must provide their full legal name to ensure the order is accurately associated with their medical records.
4. Section 2: If the patient is unable to sign the form due to medical reasons, a legally authorized representative, such as a healthcare power of attorney, may sign on behalf of the patient. In this case, the representative’s name, relationship to the patient, and contact information must be clearly provided.
5. Section 3: The patient or their authorized representative must date and sign the form, affirming their understanding and agreement to the DNR order. Witness signatures may also be required, depending on the specific circumstances and instructions provided with the form.
6. Section 4: It's crucial for the patient’s attending physician to sign and date the form, as their signature validates the DNR order, making it legally effective. Provide the physician’s name, license number, and contact information for verification purposes.

After completing all necessary sections of the form, keep the original document in an easily accessible location and provide copies to relevant family members, healthcare proxies, and the patient’s physician. Ensuring that the DNR order is readily available in case of an emergency is essential for its instructions to be followed by healthcare providers.

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

   A Do Not Resuscitate (DNR) Order is a legal form in California that instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating. It is part of a larger approach to end-of-life planning and is designed to respect the wishes of individuals who prefer not to undergo certain life-sustaining treatments in these circumstances.

2. How does one obtain a DNR Order in California?

   To obtain a DNR Order in California, an individual must discuss their wishes with a healthcare provider. The healthcare provider will then help to complete the necessary paperwork, ensuring that the form meets all legal requirements set forth by California law. It is essential for the patient, or their legal healthcare decision-maker, to fully understand the implications of the DNR Order.

3. Who can have a DNR Order?

   • Any adult who can make their own medical decisions.
   • A legal guardian or healthcare power of attorney can request a DNR order for someone unable to make their own medical decisions.
   • Parents or legal guardians can request a DNR Order for their minor children if deemed appropriate under medical advice.

4. Is a DNR Order revocable?

   Yes, a DNR Order is revocable at any time by the individual who originally requested it, or their legally authorized decision-maker. The revocation can be done verbally or by destroying the DNR form. It is crucial for the individual or the decision-maker to inform the healthcare team immediately about the decision to revoke the order to ensure the patient receives the desired level of care.

When filling out the California Do Not Resuscitate (DNR) Order form, many people make mistakes that can impact its validity and effectiveness. It's essential to complete this form accurately to ensure that your wishes regarding resuscitation are respected during a medical emergency. Below are eight common mistakes:

1. Not using the correct form: The State of California provides a specific DNR form that must be used for the order to be recognized. Using an outdated form or an incorrect template can render the document invalid.

2. Failing to include all necessary information: Every section of the DNR form needs to be completed. Missing information can lead to questions regarding the patient's true wishes and may delay the desired response from medical personnel.

3. Inaccurate patient information: Ensuring that the patient's name, date of birth, and other personal information are accurately recorded is critical. Mistakes in this area can cause confusion and may prevent the DNR order from being correctly implemented.

4. Not securing the required signatures: A valid California DNR order must be signed by the patient or their legally authorized representative and the patient's physician. Missing signatures can make the document legally unenforceable.

5. Using unclear language or alterations: Modifying the language of the form or using ambiguous terms can lead to misinterpretation of the patient's wishes by healthcare providers.

6. Failure to notify family members or caregivers: Even though not a requirement for the form's validity, not informing close family members or caregivers of the DNR order can cause distress and conflict when the order is enacted.

7. Not updating the DNR order: Medical preferences and conditions can change over time. An outdated DNR order may not accurately reflect the patient's current wishes or medical status.

8. Improper storage or accessibility of the DNR form: If the DNR order is not readily accessible or known to those who may need it, such as family members or emergency responders, it may not be followed in a crisis situation.

It is crucial to approach the completion of the California Do Not Resuscitate Order form carefully to ensure that it accurately represents the patient's wishes and meets all legal requirements. Avoiding the above mistakes can help in making the DNR order effective when needed.

When making decisions about end-of-life care, it is common to encounter a variety of necessary legal documents in addition to the California Do Not Resuscitate (DNR) Order form. These documents are designed to ensure that a person's healthcare preferences are known and respected. Here is a list of up to 10 forms and documents that are often used together with a DNR order to provide a comprehensive approach to end-of-life planning.

• Advance Health Care Directive: Specifies an individual's healthcare preferences and appoints a healthcare agent to make decisions on their behalf if they are unable to do so themselves.
• Physician Orders for Life-Sustaining Treatment (POLST): A doctor's order that outlines a plan for end-of-life care, which can include the patient's preferences about the use of intensive care and other life-sustaining treatments.
• Living Will: Documents an individual's wishes regarding medical treatment in case they become unable to communicate their decisions due to illness or incapacity.
• Medical Power of Attorney (Healthcare Proxy): Designates a person to make healthcare decisions on an individual's behalf if they are not in a condition to make decisions for themselves.
• Last Will and Testament: Indicates how a person’s possessions should be distributed after their death and can include funeral and burial preferences.
• HIPAA Authorization Form: Allows healthcare providers to share an individual's health information with specified persons.
• Durable Power of Attorney for Finances: Grants someone authority to handle an individual’s financial matters if they become incapacitated.
• Organ and Tissue Donation Registration: Indicates an individual’s consent to donate their organs and tissues upon death.
• Hospital Discharge Instructions: Though not a pre-planning document, these instructions can include important information relating to DNR orders and other care preferences following hospital treatment.
• Estate Planning Documents: This broad category can include trusts, deeds, and business succession plans that ensure an individual’s assets are managed and distributed according to their wishes.

This array of documents plays a crucial role in ensuring that an individual's healthcare and personal desires are followed, particularly in situations where they cannot communicate their wishes. They provide peace of mind not only for the person but also for their family members and healthcare providers. In navigating end-of-life choices, it's essential to consider completing these documents in conjunction with a DNR order to ensure comprehensive care planning.

The California Do Not Resuscitate (DNR) Order form is akin to an Advance Health Care Directive, as both documents guide medical professionals on the care a person desires should they become unable to communicate their wishes themselves. While a DNR specifically instructs not to administer CPR if a patient's breathing or heartbeat stops, an Advance Health Care Directive covers a broader spectrum of medical interventions and treatments, allowing individuals to outline their preferences on life-sustaining treatments, organ donation, and end-of-life care.

Similarly, a POLST (Physician Orders for Life-Sustaining Treatment) form complements the DNR by providing more detailed instructions regarding a patient's preferences for other life-sustaining treatments beyond CPR, including ventilation, intubation, and artificial nutrition and hydration. Both forms are designed to ensure that a patient's wishes concerning end-of-life care are respected, yet the POLST offers a more comprehensive overview of a patient's desires for medical intervention.

A Living Will, much like the DNR, serves as a directive for medical care in situations where a patient is unable to voice their preferences due to incapacitation. It details the patient's wishes regarding the withdrawal or withholding of life-sustaining treatment when facing a terminal illness or irreversible coma. The main difference is that a Living Will extends to a wider variety of circumstances and treatments than a DNR, which is specifically focused on not initiating CPR.

Another related document is the Medical Power of Attorney (POA), which authorizes another person to make healthcare decisions on behalf of the individual if they are unable to do so themselves. While a Medical POA covers broad decision-making authority, including accepting or refusing any medical treatment based on the patient’s known wishes or best interests, a DNR order specifically deals with the refusal of resuscitation efforts in emergency situations.

The Five Wishes document complements the DNR order by offering a holistic approach to discussing and documenting one’s care preferences, including medical, personal, emotional, and spiritual desires. It addresses who will make care decisions when the individual can no longer do so, the kind of medical treatment they want or don't want, how comfortable they wish to be, how they want people to treat them, and what they want their loved ones to know, including their wishes regarding CPR.

The Health Care Proxy form is another critical document, designating a representative to make healthcare decisions on someone's behalf under circumstances where they're incapacitated. This form, similar to the Medical POA, encompasses all medical decisions, highlighting the decision surrounding the initiation or refusal of CPR as specified in a DNR, relying on the appointed proxy to enforce the patient’s specified wishes regarding resuscitation.

An Out-of-Hospital Do Not Resuscitate Order specifically directs emergency medical personnel not to undertake resuscitation efforts if a patient experiences cardiac or respiratory arrest outside of a hospital setting. This document shares its core purpose with the conventional DNR but applies specifically when the individual is not in a hospital, ensuring their wishes are honored in any setting.

A HIPAA Release Form, while not a directive on the type of medical treatment to be received, plays a crucial role alongside the DNR by ensuring that medical providers can share information about the patient’s condition and treatment with designated individuals. This ensures that loved ones and those responsible for making medical decisions have the necessary information to do so in accordance with the patient’s desires regarding resuscitation and other treatments.

The Emergency Contact Form, although mainly informational, accompanies the DNR by identifying whom medical personnel should contact in an emergency. It ensures that the individual's chosen contacts are informed and can participate in decision-making as needed, based on previously expressed wishes like those in a DNR.

Lastly, the Organ Donation Consent Form, which may accompany or be included in advance care planning documents, specifies an individual's wishes regarding organ and tissue donation at the time of death. While primarily aimed at posthumous decisions, it intersects with the DNR in ensuring that an individual’s healthcare preferences are honored in their entirety, including the potential life-saving option of organ donation following the decision not to resuscitate.

Completing the California Do Not Resuscitate (DNR) Order form is a critical process that requires careful attention to ensure your healthcare wishes are correctly documented and respected. Here are eight essential dos and don'ts to consider:

• Do ensure you fully understand what a DNR order implies before filling out the form. It's a decision that should be made after thoughtful consideration and, ideally, discussions with healthcare providers and loved ones.
• Do make sure all required personal information is accurately completed on the form, including your full name, date of birth, and any other identifying details requested.
• Do have the form signed by the required parties, which typically include you (or your legally authorized representative) and your physician. The signatures are vital for the document's legality and enforceability.
• Do keep the original form in an easily accessible location and inform your family members or caregivers of its existence and location. In an emergency, this can save critical time and ensure your wishes are followed.
• Don't fill out the form without consulting your primary care physician or a healthcare provider knowledgeable about your medical history and condition. Their insights are crucial in making an informed decision.
• Don't use unclear or vague language. The instructions need to be clear to anyone who might read them, especially in an emergency situation where there’s no time for interpretation.
• Don't forget to review and update the form periodically. Your wishes or medical situation may change, and it's important to ensure the DNR order reflects your current desires.
• Don't neglect to inform new healthcare providers or caretakers about your DNR order. If you're under the care of new personnel or move to a different healthcare facility, they need to be aware of your wishes.

Understanding the California Do Not Resuscitate (DNR) Order form is crucial for individuals making informed decisions about their healthcare preferences, especially in emergencies. However, several misconceptions often cloud the public's understanding of what a DNR entails. It's essential to clarify these myths to ensure that decisions are based on accurate information.

• Myth 1: A DNR applies to all medical treatments. Many believe that a DNR order means no medical interventions will be made under any circumstances. However, it specifically instructs healthcare professionals not to initiate cardiopulmonary resuscitation (CPR) in the event of a cardiac or respiratory arrest. It does not preclude other life-sustaining treatments unless specified in an advance directive.

• Myth 2: Only the elderly or terminally ill can request a DNR. This misconception assumes that DNR orders are exclusively for those at the end of life. In reality, any individual, regardless of age or health status, can request a DNR, provided they understand the implications and meet the necessary legal requirements for consent.

• Myth 3: A DNR order is permanent and cannot be revoked. Another common misunderstanding is the permanence of a DNR order. In fact, a DNR can be revoked or updated at any time by the individual or their legally authorized representative, ensuring their current wishes are always respected.

• Myth 4: You can verbally inform your doctor, and they can act on it. While verbal instructions are important for discussions on care preferences, a formal, written DNR order, signed by a licensed physician or an authorized health care provider, is required for the order to be legally valid and followed by healthcare professionals.

• Myth 5: Emergency medical services (EMS) will not respond to a call if you have a DNR. People often fear that EMS will not assist them in emergencies if they have a DNR. EMS will respond to an emergency call and provide all necessary care; however, they will not proceed with CPR if a valid DNR order is presented or known.

• Myth 6: A DNR order affects the quality of care one receives. There's a concern that healthcare providers might offer a lower standard of care to individuals with a DNR. This is far from the truth, as healthcare professionals are ethically and legally obligated to provide the same level of care and respect to all patients, irrespective of their DNR status.

• Myth 7: A DNR must be notarized to be valid. While some legal documents require notarization, a DNR form in California does not. To be considered valid, it must be signed by a licensed physician or an authorized healthcare provider, indicating their agreement with the patient's wishes.

• Myth 8: A DNR is the same as an Advance Healthcare Directive. A DNR and an Advance Healthcare Directive serve different purposes. A DNR is a specific medical order not to perform CPR, while an Advance Healthcare Directive encompasses broader healthcare preferences and designates a healthcare proxy.

• Myth 9: If I change my mind, it’s too late to cancel a DNR after I’ve been admitted to a hospital. Regardless of whether one is in a hospital or not, individuals can always reassess and change their directives concerning a DNR. Communication with healthcare providers is key in ensuring that any changes are clearly documented and respected.

Breaking down these misconceptions is vital in empowering individuals to make informed choices about their health care and end-of-life wishes. Clear communication with healthcare providers and understanding the legal and practical implications of a DNR are essential steps in ensuring one's personal healthcare preferences are honored.

Understanding the California Do Not Resuscitate (DNR) Order form is essential for making informed decisions about end-of-life care preferences. Below are five key takeaways about how to properly fill out and use this form:

• Consult with a Physician: Before filling out the DNR form, it’s crucial to have a conversation with a healthcare provider. This step ensures that the individual understands the implications of a DNR order and how it influences the medical care they will receive in a life-threatening situation.

• Completion Requirements: The California DNR form must be completed accurately, including the signature of the person the DNR order is for, or a legal representative if the person is unable to sign for themselves. A physician's signature is also necessary to validate the form.

• Keep the Form Accessible: After it’s been filled out and signed, it’s important that the DNR form is kept in a place where it can be easily found by emergency responders, such as on the refrigerator or in the individual’s wallet. Some people also choose to wear a DNR bracelet for easy identification.

• Inform Family and Caregivers: Family members, caregivers, and anyone who may be involved in the individual’s healthcare decisions should be made aware of the existence and location of the DNR form. This communication ensures that everyone respects the individual's wishes regarding resuscitation efforts.

• Review and Update as Needed: The DNR order should be reviewed periodically and updated if the individual’s healthcare preferences change. It’s also advisable to discuss any updates or changes with a healthcare provider to ensure that the form accurately reflects the individual’s current wishes.