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Legal Do Not Resuscitate Order Template for California State

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 a patient's preferences about life-sustaining treatments. Understanding the implications and requirements of the DNR form is essential for both patients and their families.

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Other Common Do Not Resuscitate Order State Templates

How Do I Get a Dnr - This form emphasizes the importance of communication regarding personal health preferences.

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Example - California Do Not Resuscitate Order Form

California Do Not Resuscitate Order

This Do Not Resuscitate (DNR) Order is executed in accordance with California law, specifically under the California Health and Safety Code Section 875. With this document, individuals can express their wishes regarding resuscitation in the event of a medical emergency.

Patient Information:

Name: ___________________________
Date of Birth: ___________________
Address: _________________________
City, State, Zip: ________________

Healthcare Provider Information:

Provider Name: ____________________
Provider Phone Number: ___________
Provider Address: __________________

Patient's Wishes: I, the undersigned, wish to declare my desire to decline cardiopulmonary resuscitation (CPR) in case of cardiac arrest or cessation of breathing.

Signature: ______________________

Date: __________________________

Witness Information:

Witness Name: ____________________
Witness Signature: ________________
Date: ____________________________

This DNR Order should be presented to healthcare providers and kept in a location easily accessible to emergency personnel. It expresses my wishes regarding life-sustaining treatments and should be honored by healthcare professionals.

Documents used along the form

In the context of healthcare, particularly for individuals facing serious medical conditions, various forms and documents serve to communicate patient preferences regarding treatment and end-of-life care. Among these, the California Do Not Resuscitate (DNR) Order form is vital, but it is often accompanied by other important documents. Understanding these additional forms can empower patients and their families to make informed decisions about medical care.

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 communicate their wishes.
Physician Orders for Life-Sustaining Treatment (POLST): POLST is a medical order that translates patient preferences regarding life-sustaining treatments into actionable medical orders for healthcare providers.
Living Will: A living will specifies an individual's wishes regarding medical treatment in situations where they are terminally ill or incapacitated, particularly concerning life-sustaining measures.
Healthcare Power of Attorney: This legal document designates a person to make healthcare decisions for someone else if they are unable to do so themselves, ensuring that their medical preferences are honored.
Do Not Intubate (DNI) Order: Similar to a DNR, a DNI order specifically instructs healthcare providers not to insert a breathing tube, allowing for natural breathing to continue without mechanical assistance.
Organ Donation Consent Form: This document indicates a person's wishes regarding organ donation after death, ensuring that their preferences are respected and followed.
Patient Bill of Rights: This document outlines the rights of patients in healthcare settings, including the right to make decisions about their medical care and to receive information about their treatment options.
Divorce Settlement Agreement: The Florida PDF Forms provide essential resources for couples looking to formalize their divorce terms, including asset division and support obligations.
Medical Records Release Authorization: This form allows patients to authorize the sharing of their medical records with specific individuals or organizations, facilitating communication among healthcare providers.
End-of-Life Care Plan: This plan details the individual's preferences for care at the end of life, addressing pain management, comfort measures, and spiritual considerations.

Each of these documents plays a crucial role in ensuring that patient preferences are respected and that healthcare providers have clear guidance on how to proceed in accordance with those preferences. By familiarizing themselves with these forms, patients and their families can navigate the complexities of medical care with greater confidence and clarity.