Texas Do Not Resuscitate Order (DNR) Form

An Out-of-Hospital Do-No-Resuscitate program allows the residents of the state of Texas to decide whether or not they want to receive CPR treatment during an emergency. If a patient has a signed and activated OOH-DNR form, they will not receive CPR by medical staff in any part of the state.

The list of restricted measures includes:

  • CPR (cardiopulmonary resuscitation)
  • advanced airway treatment
  • restarting the heart via electric shock
  • artificial respiration
  • external cardiac pacing

How Can a Person Obtain an OOH-DNR form in Texas?

Any Texas resident of legal age can obtain and activate an OOH-DNR form by downloading it from the Texas Department of Health Service website and filling it out according to the state’s legal regulations.

The form itself has the following requirements:

  • It should be printed on the standard A4-size sheet of paper
  • The paper should have information on both sides—the OOH-DNR form on the front side and the instructions on the backside
  • A patient can copy the document or use an original form
  • Copies of the document are deemed legal

Two administrative rules regulate the Texas OOH-DNR Program: Rule §157.25 and Chapter 166. To legally sign an OOH-DNR form in Texas, you will need a patient, a physician, two witnesses, or a second physician.

How to Let Medical Personnel Know That You Have an OOH-DNR Order?

Once you sign your OOH-DNR order, you can get an extra DNR identification device. This is optional, so you will have to pay for this.

There are two types of DNR ID devices:

  • a plastic bracelet with the word “Texas” or the logo of the geographical shape of the state with the word “STOP” printed over it
  • a metal bracelet with the phrase “Texas Do Not Resuscitate”
  • a metal necklace with the same message

All three ID devices serve as substitutions for the printed OOH-DNR form and must be accepted by medical personnel as a legal DNR order showing that a patient exercises their right to reject certain treatment.

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Download your fillable Texas DNR form in PDF format.

Filling Out the Texas OOH-DNR Order Form

Before proceeding with filling out the DNR form, you should know that it takes more than one person to fill it out properly: you as a patient and your attending physician. You will also need two witnesses for the task.

1. Provide Your Personal Information

step 1 to filling out the texas dnr form - provide your personal information

Write down your full name, your date of birth, and specify your gender.

2. Confirm a Declaration

step 2.1 to filling out the texas dnr form - confirm a declaration

Use Section A of the document to confirm that you—as an adult patient—don’t want to receive resuscitation.

step 2.2 to filling out the texas dnr form - confirm a declaration

Use Section B of the document to confirm the declaration on behalf of a patient as their legal guardian, representative, etc.

step 2.3 to filling out the texas dnr form - confirm a declaration

Use Section C of the document to confirm the declaration as a patient’s qualified relative.

step 2.4 to filling out the texas dnr form - confirm a declaration

Use Section D of the document to confirm the declaration as a patient’s physician.

step 2.5 to filling out the texas dnr form - confirm a declaration

Use Section E of the document to confirm the declaration as an adult representative of a minor person.

NOTE: In each section, you will need to put down your signature, your printed name, and the date of signing.

3. Make Witnesses Sign the Document

step 3 to filling out the texas dnr form - make witnesses sign the document

Ask two witnesses to put their signatures, the date of signing, and their printed names.

4. Provide a Physician’s Information

step 4.1 to filling out the texas dnr form - provide a physicians information

A physician must approve the form and put down their full name, license number, signature, and date of signing.

step 4.2 to filling out the texas dnr form - provide a physicians information

NOTE: If the patient is incompetent or unable to communicate, the participation of two physicians will be necessary.

5. Provide Signatures of All Parties Involved

step 5 to filling out the texas dnr form - provide signatures of all parties involved

This is the final step where all the participants will need to put their signatures again to make the OOH-DNR order form legal.

Published: Oct 18, 2021