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. By completing this form, you ensure that your preferences are respected, relieving your loved ones of difficult decisions during critical moments. Take control of your healthcare decisions today by filling out the form; click the button below.
In California, the Do Not Resuscitate (DNR) Order form is an important document that allows individuals to express their wishes regarding medical treatment in the event of a life-threatening situation. This form is particularly relevant for those who prefer to avoid aggressive life-saving measures, such as cardiopulmonary resuscitation (CPR), when their heart stops or they stop breathing. The DNR Order must be completed and signed by a physician, ensuring that it reflects the patient's desires and medical circumstances. It is essential for individuals to discuss their choices with family members and healthcare providers, as this can lead to a better understanding of the implications of a DNR. Once completed, the form should be easily accessible, as emergency medical personnel need to be aware of the patient's wishes during critical moments. Additionally, the DNR Order is part of a broader conversation about advance healthcare planning, allowing individuals to take control of their medical care and ensure their preferences are respected. Understanding the DNR form can empower individuals to make informed decisions about their end-of-life care, fostering peace of mind for themselves and their loved ones.
California Do Not Resuscitate (DNR) Order Template
This document serves as a Do Not Resuscitate (DNR) Order pursuant to the California Health and Safety Code Section 1797.60 et seq., indicating the individual named below refuses any resuscitative measures in the event of cardiac or respiratory arrest.
Personal Information
DNR Order Declaration
I, _________________________, being of sound mind and fully understanding the consequences, hereby refuse any and all forms of resuscitative services, including but not limited to CPR (Cardiopulmonary Resuscitation), advanced airway management, artificial ventilation, defibrillation, and other invasive medical procedures intended to restore heart and lung function. This directive is to take effect immediately and to apply during any medical situation where I am unable to express my wishes.
Signature: __________________________ Date: ____________
Witness Statement
I, _________________________, declare that the individual signing this document appears to be of sound mind and free from duress. I affirm that I am not related to, nor a beneficiary of, the individual's estate and have no financial interest in their death.
Witness Signature: __________________________ Date: ____________
Physician's Statement
I, Dr. _________________________, affirm that I have discussed the implications and alternatives to a Do Not Resuscitate (DNR) order with the above-named individual (or their authorized representative) and believe they fully understand the consequences of this decision. I confirm that this DNR order is consistent with the individual's current medical condition and healthcare wishes.
Physician's Signature: __________________________ Date: ____________ License Number: ____________
This document is valid exclusively within the State of California and is intended to be recognized by emergency personnel, medical staff, and healthcare facilities within this jurisdiction. It does not preclude the individual from receiving other forms of medical care and attention.
To rescind this order, the individual must communicate their wish in a written, signed, and dated document or through a verbal declaration to their physician or healthcare provider.
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