Interim Instructions for Completing the Out of Hospital Do Not Resuscitate Order Form

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The following instructions provide suggested modifications to the Out of Hospital DNR Order (revised September 27, 1996) to comply with legislative changes effective on September 1, 1999.

These instructions specifically apply to the 8-inch by 14-inch OOH DNR order with the red logo, revised September 27, 1996.  They do not apply to the current form, which can be printed from this web site, or the form with May 17, 2000 revision date.

 • Section C: Only one qualified family member's signature is required. On the second line print "No longer required per Chapter 166, Health and Safety Code effective September 1, 1999.

 • Item 3 Witnesses: Only one witness must meet the qualifications listed on the reverse side of the form. The second witness may be any competent adult.

 • Item 4 Physician's signature: An individual is no longer required to have a terminal condition.  The physician may draw a single line through the phrase " I have diagnosed and certified in patient records that he/she is in a terminal condition", initial the change and make a note to the effect "no longer required per Chapter 166, Health and Safety code, September 1, 1999."

 • Once the original order has been properly executed and signed in the appropriate places, a photocopy or other complete facsimile of the completed form may be used for any purpose for which the original written order may be used.
 

Please contact Kelly Harrell, Texas Department of Health, at (512) 834-6700 if you need further clarification or have any questions.

Last Updated July 1, 2005