Free Downloadable Texas DNR Template: In-Hospital and Out-of-Hospital Do Not Resuscitate Forms

Are you searching for out of hospital dnr texas form, texas do not resuscitate form, in hospital do not resuscitate form texas, ooh dnr form texas, do not resuscitate texas, ooh dnr texas pdf, in hospital dnr form texas, or out of hospital dnr texas? You’re in the right place. I’ve spent more than a decade helping families, healthcare teams, and businesses craft clear, compliant forms that address real-world needs. This article covers the two main pathways you’ll see in Texas—In-Hospital DNR and Out-of-Hospital DNR (OOH-DNR)—and points you to a free downloadable template you can start using today.

Disclaimer: Not legal advice; consult pro.

Understanding DNR in Texas: In-Hospital vs Out-of-Hospital

In Texas, a Do Not Resuscitate (DNR) order is a physician-directed decision that guides medical teams on whether to perform cardiopulmonary resuscitation (CPR) if a patient stops breathing or their heart stops beating. The two main flavors you’ll encounter are:

In-Hospital DNR: An order written by a physician that governs CPR decisions while the patient is in a hospital or a hospital-affiliated setting. This form is typically filed in the medical record and is applicable to all hospital staff who would be involved in resuscitation efforts.
Out-of-Hospital DNR (OOH-DNR): A physician-ordered directive designed for EMS personnel and non-hospital settings. This form is carried by the patient or linked to their medical record to guide EMS in the event of a medical emergency outside a hospital. It’s specifically designed so responders know CPR is not to be performed unless there is a separate directive to override it.

While both forms share the same fundamental purpose—respecting a patient’s wishes about life-sustaining treatment—their scope, signatories, and the audiences they address differ. An in-hospital DNR focuses on hospital staff and procedures, while an OOH-DNR emphasizes EMS recognition and out-of-hospital care. In practice, many patients also hold additional advance directives or POLST/MOLST forms that address a broader spectrum of decisions beyond CPR, such as intubation, feeding tubes, and future hospitalizations.

When you’re making or reviewing these forms, it helps to keep a few realities in sight: the DNR order is a medical order, not a consent form, and it must align with the patient’s values and medical prognosis. It’s also essential to verify how your local hospital or EMS agency recognizes DNR orders, because some agencies will require specific wording, a particular color or format, or a separate portable card. With Texas’ system, the two main forms you’ll encounter are designed to work together, but you’ll want to confirm the exact procedures with your physician, hospital, and local EMS providers.

Free Downloadable Template: What’s Included and How It Helps

To support your planning, I’ve included a free downloadable template that covers both in-hospital and out-of-hospital needs in a single, easy-to-use document. The template is designed to be clear for patients and families, straightforward for clinicians, and simple for EMS to recognize in the field. It’s not a substitute for individualized legal or medical advice, but it provides a solid, compliant starting point you can customize and print.

Patient information: Full legal name, date of birth, contact information, and any applicable patient identifiers to minimize confusion.
Physician orders: Clear language authorizing or declining CPR and other resuscitation measures, signed by the treating physician and dated.
OOH-DNR details: Specific language tailored for out-of-hospital care, including EMS recognition language and any location-specific notes.
Signatures and dates: Spaces for patient or legally authorized representative signatures, as well as witness or notary, depending on state or institutional requirements.
Location indicators: Checkboxes or notes identifying whether the order is in-hospital, out-of-hospital, or both, plus where copies exist (e.g., medical record, EMS packet).
Emergency instructions: Brief guidance for caregivers about preferred levels of intervention, goals of care, comfort measures, and palliative considerations.
Portable copy: A version that can be printed as a small card or card-sized insert for easy carrying in a wallet or purse.
Notes and reminders: A dedicated space for remarks about the patient’s prognosis, specific concerns, or preferred treatment settings (for example, preferences for hospice or palliative care).

With the template, you’ll see language that aligns with common practice in Texas for both in-hospital and out-of-hospital contexts. The document is designed to be visually clear, so that healthcare providers in a pressure-filled moment can locate and interpret the patient’s wishes quickly and accurately. You can download the template here:

Download the free Texas DNR template (PDF)

Remember: laws, forms, and EMS recognition can vary by jurisdiction and over time. Use the template as a foundation, then confirm the exact requirements with your physician, the hospital’s physician orders department, and your local EMS agency. If you have a life-limiting condition or are coordinating care for a loved one, a physician or elder-law attorney can tailor the document to your circumstances while ensuring it complies with Texas law at the time of use.

How to Fill the Texas DNR Form: A Practical Step-By-Step Guide

Filling out a DNR form can feel daunting, but breaking it into steps helps you stay organized and accurate. Here’s a practical approach I use with families and care teams in Texas, with emphasis on both in-hospital and out-of-hospital contexts.

Clarify goals of care: Before touching the form, discuss with the patient (or their substitute decision-maker) what outcomes matter most, such as avoiding aggressive resuscitation, preserving comfort, or prioritizing quality of life in light of prognosis.
Consult the clinician: Have the patient’s physician review the medical situation and determine whether CPR would be futile or harmful given the current condition. The physician’s order is central to any DNR decision.
Choose the DNR type: Decide whether the decision will apply purely within the hospital setting, or also outside the hospital (OOH-DNR). If you anticipate situations outside the hospital, prepare the out-of-hospital language to accompany the in-hospital order.
Complete patient information: Fill in full legal name, date of birth, address, and contact information. Ensure all fields are legible and consistent with the patient’s identification documents.
Record the physician order: The physician signs and dates the order, confirming the resuscitation preferences. Ensure the language clearly states whether CPR should be attempted or withheld.
Include EMS-facing details for OOH-DNR: If the patient will rely on EMS outside the hospital, include specific EMS instructions, including any conditions or exceptions that could require resuscitation in certain scenarios.
Signatures and witnesses: Obtain the patient’s signature or the signature of the legally authorized representative. Check whether Texas institutions require witnesses or a notary and arrange accordingly.
Distribute copies: Place the original in the medical record, provide a copy to the patient or SDM, keep a portable copy for easy access, and ensure EMS and caregivers have the relevant documents.
Review and update: Health status can change, so set reminders to review the DNR form periodically or after major health shifts, hospital admissions, or transitions in care (e.g., hospice).

To maximize clarity, label the form with the date of the order and the version of the template you’re using. If you’re using the OOHDNR (out-of-hospital DNR) component, explicitly note that the order is in effect for EMS transport and not just a hospital setting. The goal is to reduce ambiguity in emergencies when seconds count.

Where to Use and How to Carry the DNR Documentation

In practice, you’ll use these forms in a few common contexts:

Hospital settings: In-hospital DNR orders govern treatments when the patient is admitted or receiving care within a hospital facility. The form should be part of the patient’s medical record and readily accessible to the care team.
Ambulatory or outpatient settings: If the patient spends significant time outside a hospital (home, assisted living, etc.), ensure the OOHDNR is carried or accessible to caregivers who may be first responders.
EMS activation: The OOHDNR should be recognized by EMS personnel when a 911 call is answered, allowing them to honor the patient’s resuscitation preferences in the field.
Hospices and palliative care programs: These programs often coordinate with DNR orders to ensure consistency across settings, including home-based care.

Carrying a portable copy or wallet card with the key elements of the DNR order (name, date, physician signature, and the explicit resuscitation instruction) can be practical for emergencies away from home. If you’re using the free template, consider printing a compact version suitable for wallet storage and keep a full-length version in the patient’s medical record.

Legal and Practical Considerations in Texas

Texas law recognizes DNR orders as medical orders that guide treatment during emergencies and hospital care. However, what’s needed for a valid DNR can vary by facility and jurisdiction. A few practical considerations can help you avoid common missteps:

Consistency with other directives: Align the DNR order with any POLST/MOLST forms, advance directives, and organ donation preferences. Conflicts between documents can complicate decisions during emergencies.
Physician involvement: A DNR order typically requires a physician’s input and signature. Ensure the physician reviews the patient’s medical status and prognosis before finalizing the order.
Recognition by EMS: If the DNR is intended for out-of-hospital use, verify that EMS in the patient’s area recognizes the form you’ve chosen. Some EMS agencies have preferred formats or require specific identifiers.
Household and facility policies: Some facilities or care settings have internal requirements for DNR forms, including additional witnesses or notary steps. Always confirm with the facility before submission.
Revocation and updates: If the patient’s wishes change, or if medical status changes, promptly update or revoke the DNR order. Track the date of any changes and circulate updated copies to all relevant parties.
Privacy and access: Respect patient privacy when distributing copies. Ensure only authorized individuals have access to the full medical order, while still making it accessible to caregivers and EMS when needed.

For readers who want to understand the broader financial implications that can intersect with medical directives, you can explore IRS guidance about medical expenses. While not a legal substitute for medical or estate planning, it’s useful context for families navigating procedural costs and potential deductions. See IRS resources such as:

These IRS pages offer general information about medical expenses and deductions, which can be relevant in planning for healthcare costs associated with end-of-life care. They are not substitutions for legal or medical advice about DNR orders, but they provide context that families often find useful.

Common Questions About Texas DNR Orders

Below are some questions I hear frequently from patients, families, and care teams who are navigating in-hospital and out-of-hospital DNR decisions in Texas. The answers reflect practical experience and typical clinical workflows.

Can a DNR be reversed? Yes. A patient or SDM can revoke or modify a DNR order at any time, provided the patient has decision-making capacity or a legally authorized representative can act on their behalf. It’s important to communicate changes promptly to the treating team and update all copies of the form.
Do DNR orders impact other treatments? A DNR primarily addresses resuscitation in the event of cardiac or respiratory arrest. It does not automatically limit other life-sustaining or comfort-focused interventions unless the physician documents a broader scope of care limitations.
Is a DNR the same as hospice? No. DNR is a medical order about CPR, while hospice focuses on comprehensive care for comfort near end of life, usually with a broader plan about symptom management and goals of care. The two can and do coexist, but they’re not interchangeable.
What if I don’t have a Texas DNR form? If there is no valid DNR form, healthcare providers may perform CPR or other interventions per standard medical practice. It’s best to discuss with your clinician and obtain an appropriate DNR order that aligns with current wishes and medical realities.
How do I ensure EMS will honor an OOHDNR? Work with your physician and local EMS agency to ensure the form is recognized. Some agencies require specific formatting, color coding, or portable copies. Carry a wallet card or keep an accessible copy in your patient’s home and car where allowed.

Additional Considerations: POLST/MOLST, Advance Directives, and Family Discussions

Modern care planning often extends beyond a single DNR order. A POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) form translates preferences into actionable medical orders that are recognized across settings, including EMS, hospitals, and hospices. In Texas, POLST/MOLST programs are widely used, but the exact format and acceptance can vary by region. If you’re completing a DNR in Texas, consider whether a POLST/MOLST form or a broader advance directive exists for the patient. Aligning documents reduces ambiguity and helps ensure the patient’s values drive care across settings.

Family discussions are equally important. A clear conversation about goals, prognosis, and the typical outcomes of CPR in different medical contexts helps avoid last-minute confusion. In my work with families, I’ve seen how documenting preferences through a well-organized template reduces stress during emergencies and provides a consistent reference for clinicians and EMS alike.

About the Free Template: Best Practices and Accessibility

The free template is designed with accessibility in mind. It’s formatted to be legible, printer-friendly, and adaptable to your local requirements. When you distribute or file copies, keep the following in mind:

Clarity over complexity: Use plain language for resuscitation decisions so that caregivers and first responders can interpret the order quickly in a crisis.
Consistency across settings: Where possible, ensure alignment with hospital policies, EMS protocols, and any POLST/MOLST forms in use.
Version control: Include the version date on the form and keep the latest copy in both the patient’s medical record and a portable packet for emergencies.
Legal considerations: While the template provides a solid structure, it does not replace individualized legal advice. If you have questions about state-specific requirements or unique circumstances, consult a qualified attorney.

As you work with the template, remember that the DNR order is a medical directive. Its authority comes from physician orders and institutional policies, and the patient’s values guide the decision-making process. The template is a tool to help you capture those preferences clearly and consistently.

Practical Tips for Texas Families and Care Providers

Start early: Begin the conversation before a crisis occurs, ideally when the patient is healthy enough to participate meaningfully in decisions about future treatment preferences.
Coordinate with your care team: Share the plan with primary care physicians, hospitalists, palliative care specialists, and social workers to ensure everyone understands the patient’s wishes.
Keep key documents accessible: Store the DNR order in the patient’s medical record, provide a portable copy to the SDM, and maintain a wallet-sized card for quick reference in emergencies.
Review periodically: Revisit the form during major health changes, hospital admissions, or transitions to different levels of care (home health, hospice, or long-term care facilities).
Respect the patient’s autonomy: DNR decisions are about aligning care with patient values. Respect for patient autonomy remains a cornerstone of medical ethics and Texas practice.

Download, Customize, and Use: Quick Start

To get started, download the free Texas DNR template from the link above. Customize it with the patient’s information, ensure physician sign-off, and distribute copies to the patient, SDM, hospital records, and EMS-appropriate channels. If you’re unsure about any field, consult the patient’s physician or a qualified attorney who specializes in end-of-life planning. The goal is to create a document that is immediately interpretable by clinicians, reduces ambiguity, and honors the patient’s care preferences.

Not legal advice; consult pro.

Key Takeaways

Texas recognizes both In-Hospital DNR orders and Out-of-Hospital DNR (OOH-DNR) orders, each with specific uses and audiences.
A free downloadable template can help you capture clear, compliant directions for resuscitation across settings.
Coordinate with physicians, hospitals, EMS, and any POLST/MOLST programs to ensure consistency and reduce confusion during emergencies.
Keep the documents up to date and accessible to patients, SDMs, and care providers, with copies for medical records and EMS recognition.

Sources and Further Reading

For readers seeking additional context about related topics, a couple of reputable sources you may find useful include:

These IRS resources provide general information about medical expenses and deductions that often appear in conversations about end-of-life planning and the cost implications of care. They are not substitutes for legal or medical advice about DNR orders or Texas-specific procedures.

Would you like extra help?

If you’d like personalized guidance, I can walk you through tailoring the template to your specific situation, explain how to coordinate with your local hospital or EMS, or help you prepare to discuss these decisions with your loved ones. I’ve found that a calm, well-documented plan reduces stress for families during difficult moments and makes the care providers’ job more straightforward when every second counts.

And if you’re ready to start, don’t wait for a crisis. Download the free Texas DNR template now, customize it, and arrange a quick review with a physician or attorney who can confirm it aligns with current Texas law and best practices in your area.