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In California, the Do Not Resuscitate (DNR) Order form serves as a crucial document for individuals wishing to express their preferences regarding medical treatment in the event of a life-threatening situation. This form allows patients to communicate their desire to forgo resuscitation efforts, such as CPR or advanced life support, should their heart stop beating or they stop breathing. Completing a DNR Order is not just a matter of paperwork; it involves thoughtful consideration of one’s values and wishes regarding end-of-life care. The form must be signed by the patient or their legal representative and requires a physician's signature to be valid. Additionally, it is essential for the DNR Order to be easily accessible to healthcare providers, ensuring that medical teams are aware of the patient’s wishes at critical moments. Understanding how to properly fill out and utilize this form can empower individuals to take control of their healthcare decisions, providing peace of mind for both patients and their loved ones.
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Dos and Don'ts
When filling out the California Do Not Resuscitate Order form, it is crucial to follow specific guidelines to ensure that your wishes are respected. Here are four things you should and shouldn't do:
- Do ensure that you are of sound mind when completing the form.
- Do consult with your healthcare provider to understand the implications of your decision.
- Don't leave any sections of the form incomplete, as this may lead to confusion about your wishes.
- Don't forget to sign and date the form, as an unsigned document may not be considered valid.
California Do Not Resuscitate Order Sample
California Do Not Resuscitate Order Template
This Do Not Resuscitate (DNR) Order is created in accordance with California law. It allows individuals to express their wishes regarding resuscitation efforts in case of a medical emergency.
Patient Information:
- Name: _______________________________
- Date of Birth: _______________________
- Address: _____________________________
- Medical Record Number: ______________
Medical Provider Information:
- Name: _______________________________
- Address: _____________________________
- Phone Number: _______________________
Order Statement:
I, the undersigned, do not wish to receive resuscitation efforts, including cardiopulmonary resuscitation (CPR), if my heart stops or if I stop breathing. This order expresses my wishes regarding my medical care.
Patient Signature:
_______________________________
Date: _______________
Witness Information:
- Witness 1 Name: ________________________
- Witness 1 Signature: ____________________
- Date: _______________
- Witness 2 Name: ________________________
- Witness 2 Signature: ____________________
- Date: _______________
This DNR order must be presented to medical personnel to be honored. It may be revoked by me at any time.
Listed Questions and Answers
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What is a Do Not Resuscitate (DNR) Order?
A Do Not Resuscitate Order is a legal document that allows an individual to refuse specific medical interventions, particularly cardiopulmonary resuscitation (CPR), in the event of a cardiac arrest or respiratory failure. This order is designed to ensure that a person's wishes regarding end-of-life care are respected. It is essential for individuals who have a terminal illness or a condition that significantly limits their quality of life.
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Who can complete a DNR Order in California?
In California, a DNR Order can be completed by a patient who is of sound mind and understands the implications of the decision. If the patient is unable to make their own decisions, a legally authorized representative, such as a family member or a healthcare proxy, may complete the form on their behalf. It is important that the individual completing the form fully understands the patient's wishes and medical condition.
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How do I obtain a DNR Order form in California?
Individuals can obtain a DNR Order form from various sources, including hospitals, healthcare providers, and online resources. The California Department of Public Health provides a standardized DNR form that can be downloaded from its website. It is advisable to consult with a healthcare professional when completing the form to ensure that it accurately reflects the individual's wishes and complies with state laws.
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What should I do after completing a DNR Order?
Once a DNR Order is completed, it is crucial to ensure that it is easily accessible. Keep a copy in a prominent place, such as a refrigerator or a bedside table, where emergency responders can find it. Additionally, inform family members, caregivers, and healthcare providers about the existence of the DNR Order. Clear communication will help ensure that the individual's wishes are honored in a medical emergency.
PDF Characteristics
| Fact Name | Description |
|---|---|
| Purpose | The California Do Not Resuscitate Order (DNR) form allows individuals to express their wishes regarding resuscitation efforts in the event of a medical emergency. |
| Governing Law | This form is governed by California Health and Safety Code Section 7180-7190, which outlines the legal framework for advance healthcare directives. |
| Eligibility | Any adult individual who is capable of making medical decisions can complete a DNR order. This includes patients with terminal conditions or those who wish to avoid aggressive resuscitation efforts. |
| Signature Requirements | The DNR form must be signed by the individual or their legal representative and requires the signature of a physician to be valid. |