Get the free In-Hospital Do-Not-Resuscitate Order

Hospital DoNotResuscitate Order Advance Directives Act (see 166.203, Texas Health and Safety Code)After being admitted to the hospital, you or your legal guardian or agent under a medical power of attorney

How to fill out in-hospital do-not-resuscitate order

How to fill out in-hospital do-not-resuscitate order

1. To fill out an in-hospital do-not-resuscitate order, follow these steps:
2. Consult with the attending physician or healthcare provider: Discuss your decision to have a do-not-resuscitate order and seek their guidance.
3. Understand the implications: Make sure you have a clear understanding of what a do-not-resuscitate order entails and its potential impact on your care.
4. Obtain the necessary forms: Ask the healthcare provider for the specific forms required to fill out the do-not-resuscitate order. These forms may vary depending on the healthcare facility or jurisdiction.
5. Provide your personal information: Fill out the form with your full name, date of birth, address, and contact information.
6. Indicate your decision: Clearly state your decision to have a do-not-resuscitate order, ensuring it aligns with your wishes and values.
7. Sign and date the form: Read the form carefully, then sign and date it in the designated fields. This confirms your consent and understanding of the do-not-resuscitate order.
8. Discuss with loved ones: Communicate your decision to your family, close friends, or healthcare proxies to ensure they are aware and supportive.
9. Provide a copy to the healthcare facility: Hand over the completed form to the healthcare provider or facility staff responsible for maintaining medical records.
10. Keep a copy for personal records: Retain a copy of the do-not-resuscitate order for your personal records and share it with any relevant healthcare providers involved in your care.
11. Review periodically: As your medical condition or preferences may change over time, consider reviewing the do-not-resuscitate order periodically to ensure it accurately reflects your current wishes.

Who needs in-hospital do-not-resuscitate order?

1. In-hospital do-not-resuscitate orders are relevant for individuals who have made a thoughtful decision to refuse resuscitation measures in the event of cardiac or respiratory arrest while staying in a hospital.
2. The need for a do-not-resuscitate order varies from person to person and can be influenced by factors such as terminal illness, advanced age, irreversible health conditions, personal beliefs, or the desire to avoid unnecessary invasive interventions.
3. It is essential for individuals who want to have control over their end-of-life decisions to have an in-hospital do-not-resuscitate order in place. This order ensures that healthcare providers respect their wishes and avoid performing cardiopulmonary resuscitation (CPR) or other resuscitative measures.

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