DSHS Do Not Resuscitate Forms

The Texas Department of State Health Services (DSHS) maintains a page with forms for use in the Out-of-Hospital Do-Not-Resuscitate program. 

The program allows people to decide that they do not want to be resuscitated. It allows people to declare that certain resuscitative measures will not be used on them. Those resuscitative measures specifically listed in the law are cardiopulmonary resuscitation (CPR), advanced airway management, defibrillation, artificial ventilations, and transcutaneous cardiac pacing.

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Specifications regarding the Out of Hospital Do-Not-Resuscitate (OOH DNR) form: 

  • The OOH DNR Order form is on standard letter-size paper, 8 1/2 inches by 11 inches.
  • The form can be copied and used as an original.
  • The form should be printed with the OOH DNR Order form on the front and the instructions on the back of the sheet.
  • Copies of an executed DSHS Standard OOH DNR Order can be made and are legal, binding documents.
 

Last Updated On

August 22, 2024

Originally Published On

August 27, 2014

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